Provider Demographics
NPI:1477143709
Name:KINTIGH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KINTIGH CHIROPRACTIC LLC
Other - Org Name:WATER'S EDGE SPINE AND SPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KINTIGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-513-2097
Mailing Address - Street 1:PO BOX G
Mailing Address - Street 2:
Mailing Address - City:FRUITPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49415-0907
Mailing Address - Country:US
Mailing Address - Phone:231-366-6035
Mailing Address - Fax:231-366-6073
Practice Address - Street 1:14 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:FRUITPORT
Practice Address - State:MI
Practice Address - Zip Code:49415-9699
Practice Address - Country:US
Practice Address - Phone:231-366-6035
Practice Address - Fax:231-366-6073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty