Provider Demographics
NPI:1225230832
Name:KRYNEN CHIROPRACTIC INC
Entity Type:Organization
Organization Name:KRYNEN CHIROPRACTIC INC
Other - Org Name:STEVEDORES PHYSICAL REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRYNEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-549-4999
Mailing Address - Street 1:123 E F ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-5817
Mailing Address - Country:US
Mailing Address - Phone:310-549-4999
Mailing Address - Fax:310-549-6942
Practice Address - Street 1:123 E F ST
Practice Address - Street 2:SUITE H
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-5817
Practice Address - Country:US
Practice Address - Phone:310-549-4999
Practice Address - Fax:310-549-6942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0148510Medicare UPIN