Provider Demographics
NPI:1447672043
Name:JIMENEZ, STACY KORRINE (DC)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:KORRINE
Last Name:JIMENEZ
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 1:18122 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-9532
Mailing Address - Country:US
Mailing Address - Phone:913-730-1800
Mailing Address - Fax:913-730-1804
Practice Address - Street 1:18122 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-9532
Practice Address - Country:US
Practice Address - Phone:913-730-1800
Practice Address - Fax:913-730-1804
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS50198021OtherBCBS PROVIDER #
KS50415017OtherBCBS GROUP #