Provider Demographics
NPI:1215140546
Name:KIMMEY, DOUGLAS G (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:G
Last Name:KIMMEY
Suffix:
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 1:5332 WILLIAM FLYNN HWY
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9650
Mailing Address - Country:US
Mailing Address - Phone:724-444-1066
Mailing Address - Fax:724-444-1068
Practice Address - Street 1:5332 WILLIAM FLYNN HWY
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9650
Practice Address - Country:US
Practice Address - Phone:724-444-1066
Practice Address - Fax:724-444-1068
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-04785-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKI-674483Medicare ID - Type Unspecified