Provider Demographics
NPI:1982646873
Name:CARPENTER, KIMBERLY BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:BETH
Last Name:CARPENTER
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 1:161 SAINT MATTHEWS AVE STE 13
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3145
Mailing Address - Country:US
Mailing Address - Phone:502-454-3500
Mailing Address - Fax:502-454-3015
Practice Address - Street 1:161 SAINT MATTHEWS AVE STE 13
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3145
Practice Address - Country:US
Practice Address - Phone:502-454-3500
Practice Address - Fax:502-454-3015
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9514Medicare PIN