Provider Demographics
NPI:1487752788
Name:QUALLS, KIMRA S (DC)
Entity type:Individual
Prefix:DR
First Name:KIMRA
Middle Name:S
Last Name:QUALLS
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 1:503 E. BERTRAND
Mailing Address - Street 2:
Mailing Address - City:ST. MARYS
Mailing Address - State:KS
Mailing Address - Zip Code:66536
Mailing Address - Country:US
Mailing Address - Phone:785-437-6162
Mailing Address - Fax:785-437-6197
Practice Address - Street 1:503 E. BERTRAND
Practice Address - Street 2:
Practice Address - City:ST. MARYS
Practice Address - State:KS
Practice Address - Zip Code:66536
Practice Address - Country:US
Practice Address - Phone:785-437-6162
Practice Address - Fax:785-437-6197
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU70488Medicare UPIN
KS060443Medicare ID - Type UnspecifiedKIMRA QUALLS D.C.