Provider Demographics
NPI:1477805844
Name:KINUM CHIROPRACTIC PC
Entity Type:Organization
Organization Name:KINUM CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:KINUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-382-0055
Mailing Address - Street 1:201GLEN AVE.
Mailing Address - Street 2:
Mailing Address - City:SCOTA
Mailing Address - State:NY
Mailing Address - Zip Code:12302
Mailing Address - Country:US
Mailing Address - Phone:518-382-0055
Mailing Address - Fax:518-382-0099
Practice Address - Street 1:201GLEN AVE.
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302
Practice Address - Country:US
Practice Address - Phone:518-382-0055
Practice Address - Fax:518-382-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty