Provider Demographics
NPI:1962430629
Name:ANDERSON, KIMBERLY S (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:S
Last Name:ANDERSON
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 1:50 FILER ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2726
Mailing Address - Country:US
Mailing Address - Phone:231-723-2221
Mailing Address - Fax:231-723-5078
Practice Address - Street 1:50 FILER ST
Practice Address - Street 2:SUITE 216
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2726
Practice Address - Country:US
Practice Address - Phone:231-723-2221
Practice Address - Fax:231-723-5078
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor