Provider Demographics
NPI:1861430878
Name:WOUDSMA-WORTH, KIMBERLY A (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:WOUDSMA-WORTH
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 1:606 GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1802
Mailing Address - Country:US
Mailing Address - Phone:215-836-8888
Mailing Address - Fax:215-836-1588
Practice Address - Street 1:606 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1802
Practice Address - Country:US
Practice Address - Phone:215-836-8888
Practice Address - Fax:215-836-1588
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008025L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWO1586226OtherPA BLUE SHIELD PROVIDER N
PA7787438OtherAETNA PPO PROVIDER #
PA2269666000OtherKEYSTONE HMO PROVIDER NUM
PA3047392OtherAETNA HMO PROVIDER
PA056192Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID