Provider Demographics
NPI:1427173442
Name:CHATFIELD, KIMBALL BRADLEY (LAC)
Entity type:Individual
Prefix:DR
First Name:KIMBALL
Middle Name:BRADLEY
Last Name:CHATFIELD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 JAMES AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-4348
Mailing Address - Country:US
Mailing Address - Phone:530-541-1999
Mailing Address - Fax:
Practice Address - Street 1:2241 JAMES AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-4348
Practice Address - Country:US
Practice Address - Phone:530-541-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2459171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist