Provider Demographics
NPI:1831276906
Name:KIMBLE, ROBERT BRENT II (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRENT
Last Name:KIMBLE
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 AZTEC TRL
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-1503
Mailing Address - Country:US
Mailing Address - Phone:304-839-6563
Mailing Address - Fax:
Practice Address - Street 1:102 ELDEN ST STE 13
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4827
Practice Address - Country:US
Practice Address - Phone:703-742-5470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor