1407884414 NPI number — DR. KIMBERLY RANDOLPH JES D.C.

Table of content: DR. KIMBERLY RANDOLPH JES D.C. (NPI 1407884414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407884414 NPI number — DR. KIMBERLY RANDOLPH JES D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JES
Provider First Name:
KIMBERLY
Provider Middle Name:
RANDOLPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407884414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15015 S 13TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85048-6241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-569-0529
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
177 W COTTONWOOD LN
Provider Second Line Business Practice Location Address:
#13
Provider Business Practice Location Address City Name:
CASA GRANDE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85222-2552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-423-2601
Provider Business Practice Location Address Fax Number:
520-876-4599
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  7519 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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