Provider Demographics
NPI:1386396018
Name:AMBER N. KINGSLEY D.C., INC, A CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:AMBER N. KINGSLEY D.C., INC, A CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:N
Authorized Official - Last Name:KINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:209-549-2215
Mailing Address - Street 1:1012 CARVER RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4732
Mailing Address - Country:US
Mailing Address - Phone:209-549-2215
Mailing Address - Fax:209-549-2216
Practice Address - Street 1:1012 CARVER RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4732
Practice Address - Country:US
Practice Address - Phone:209-549-2215
Practice Address - Fax:209-549-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty