Provider Demographics
NPI:1164516258
Name:KISSEL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KISSEL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-391-3915
Mailing Address - Street 1:314 FLANDERS RD
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1727
Mailing Address - Country:US
Mailing Address - Phone:860-739-3600
Mailing Address - Fax:860-739-3601
Practice Address - Street 1:314 FLANDERS RD
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1727
Practice Address - Country:US
Practice Address - Phone:860-739-3600
Practice Address - Fax:860-739-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001485Medicare PIN