Provider Demographics
NPI:1841300357
Name:CHITWOOD, KIMBERLY (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:CHITWOOD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10423 OLD HWY 54,
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW BLOOMFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65063
Mailing Address - Country:US
Mailing Address - Phone:573-298-1900
Mailing Address - Fax:
Practice Address - Street 1:10423 OLD HWY 54,
Practice Address - Street 2:SUITE B
Practice Address - City:NEW BLOOMFIELD
Practice Address - State:MO
Practice Address - Zip Code:65063
Practice Address - Country:US
Practice Address - Phone:573-298-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006012186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor