Provider Demographics
NPI:1255665626
Name:LATONA-BRZEZINSKI, KRISTEN MARIE
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:MARIE
Last Name:LATONA-BRZEZINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 WEHRLE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7021
Mailing Address - Country:US
Mailing Address - Phone:716-616-9000
Mailing Address - Fax:716-408-3222
Practice Address - Street 1:2316 WEHRLE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7021
Practice Address - Country:US
Practice Address - Phone:716-616-9000
Practice Address - Fax:716-408-3222
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
NY0119061111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program