Provider Demographics
NPI:1164438784
Name:KINTZ, CHRISTOPHER (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:KINTZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39915 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 750
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2153
Mailing Address - Country:US
Mailing Address - Phone:248-476-7775
Mailing Address - Fax:248-476-7255
Practice Address - Street 1:39915 GRAND RIVER AVE
Practice Address - Street 2:SUITE 750
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2153
Practice Address - Country:US
Practice Address - Phone:248-476-7775
Practice Address - Fax:248-476-7255
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICK008382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F336810OtherBCBSM
MIU90811Medicare UPIN
MIP43550001Medicare PIN