Provider Demographics
NPI:1285751891
Name:BIBEAU, KIMBERLY G (LAC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:G
Last Name:BIBEAU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 ROGUE RIVER HWY
Mailing Address - Street 2:PMB 325
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-1600
Mailing Address - Country:US
Mailing Address - Phone:541-476-3331
Mailing Address - Fax:
Practice Address - Street 1:215 SE 6TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2404
Practice Address - Country:US
Practice Address - Phone:541-476-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00524171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist