Provider Demographics
NPI:1396097192
Name:MCCUTCHEN, KIMBERLY (DC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MCCUTCHEN
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 1:2625 BUTTERFIELD RD
Mailing Address - Street 2:STE 301N
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1234
Mailing Address - Country:US
Mailing Address - Phone:630-468-1824
Mailing Address - Fax:630-701-1007
Practice Address - Street 1:116 TOWNE CENTER DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-2027
Practice Address - Country:US
Practice Address - Phone:859-226-0303
Practice Address - Fax:859-226-0386
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor