Provider Demographics
NPI:1801164280
Name:CROWLEY, KIMBERLY NICOLE RUMACK (DC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NICOLE RUMACK
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:NICOLE
Other - Last Name:RUMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:P.O. BOX 8496
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158
Mailing Address - Country:US
Mailing Address - Phone:530-307-2310
Mailing Address - Fax:530-544-5306
Practice Address - Street 1:2877 LAKE TAHOE BLVD.
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96151
Practice Address - Country:US
Practice Address - Phone:530-494-3929
Practice Address - Fax:530-544-5306
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32133111N00000X
CADC32133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor