Doctor Name: | DR. KIMBERLY SUE LAKE |
NPI Number: | 1376594713 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.C. |
License Number: | 06869 |
Business Practice Address: | 2525 Kimberly Rd Ste #1 Bettendorf, IA - 527223538 |
Business Phone Number: | 5633440777 |
Business Fax Number: | 5633440888 |
Mailing Address: | 2525 Kimberly Rd, Ste #1 BETTENDORF |
State: | IA |
Postal Code: | 527223538 |
Phone Number: | 5633440777 |
Fax Number: | 5633440888 |
NPI Enumeration Date: | 05/12/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 06869 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |