Provider Demographics
NPI:1356483143
Name:NIGHTINGALE, KEVIN M (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:NIGHTINGALE
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 1:154 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2345
Mailing Address - Country:US
Mailing Address - Phone:716-204-0784
Mailing Address - Fax:716-204-0786
Practice Address - Street 1:154 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2345
Practice Address - Country:US
Practice Address - Phone:716-204-0784
Practice Address - Fax:716-204-0786
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3483111N00000X
NYX011221-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor