Provider Demographics
NPI:1871057737
Name:KINGSLEY, AMBER MARIE (DC, DIBCN)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:MARIE
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:DC, DIBCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 GELDING CT
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-3132
Mailing Address - Country:US
Mailing Address - Phone:810-625-1077
Mailing Address - Fax:
Practice Address - Street 1:2090 S NOVA RD # 216
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-8834
Practice Address - Country:US
Practice Address - Phone:386-262-5916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12674111N00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor