Provider Demographics
NPI:1548338742
Name:KIMBALL, WALTER FRANKLIN (DC)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:FRANKLIN
Last Name:KIMBALL
Suffix:
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 1:609 VINE ST
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5132
Mailing Address - Country:US
Mailing Address - Phone:315-451-2225
Mailing Address - Fax:315-451-2617
Practice Address - Street 1:609 VINE ST
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5132
Practice Address - Country:US
Practice Address - Phone:315-451-2225
Practice Address - Fax:315-451-2617
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV05007Medicare UPIN
NYIA0730Medicare ID - Type Unspecified