Provider Demographics
NPI:1528181054
Name:KIMPTON, SUSAN D (LAC, MSTCM)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:D
Last Name:KIMPTON
Suffix:
Gender:F
Credentials:LAC, MSTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W ABRIENDO AVE
Mailing Address - Street 2:SUITE B.
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1868
Mailing Address - Country:US
Mailing Address - Phone:719-543-3226
Mailing Address - Fax:
Practice Address - Street 1:226 W ABRIENDO AVE
Practice Address - Street 2:SUITE B.
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1868
Practice Address - Country:US
Practice Address - Phone:719-543-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1114171100000X
HI457171100000X
CA5861171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist