Provider Demographics
NPI:1144352410
Name:KIRK, KEMP BRADLEY I (DC)
Entity type:Individual
Prefix:DR
First Name:KEMP
Middle Name:BRADLEY
Last Name:KIRK
Suffix:I
Gender:M
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:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-0578
Mailing Address - Country:US
Mailing Address - Phone:386-439-9099
Mailing Address - Fax:386-439-9091
Practice Address - Street 1:212 MOODY BLVD
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-3372
Practice Address - Country:US
Practice Address - Phone:386-439-9099
Practice Address - Fax:386-439-9091
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8334111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70928Medicare UPIN
FL70928AMedicare ID - Type UnspecifiedMEDICARE #