Provider Demographics
NPI:1043471550
Name:MIRRA, KIMBERLY KATHLEEN (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KATHLEEN
Last Name:MIRRA
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 1:191 CHRISTIANA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3024
Mailing Address - Country:US
Mailing Address - Phone:302-328-2656
Mailing Address - Fax:302-328-5870
Practice Address - Street 1:191 CHRISTIANA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3024
Practice Address - Country:US
Practice Address - Phone:302-328-2656
Practice Address - Fax:302-328-5870
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010031111N00000X
DEF1-0000748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor