Provider Demographics
NPI:1528130028
Name:KEGEL, KIMBERLY KAE (DC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAE
Last Name:KEGEL
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:BOX 94
Mailing Address - Street 2:
Mailing Address - City:REFTON
Mailing Address - State:PA
Mailing Address - Zip Code:17568-0094
Mailing Address - Country:US
Mailing Address - Phone:717-786-3784
Mailing Address - Fax:
Practice Address - Street 1:1501 BEAVER VALLEY PIKE
Practice Address - Street 2:
Practice Address - City:REFTON
Practice Address - State:PA
Practice Address - Zip Code:17568-0094
Practice Address - Country:US
Practice Address - Phone:717-786-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002403L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA099518Medicare ID - Type Unspecified