Provider Demographics
NPI:1710046040
Name:PINKUS, KATHLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:PINKUS
Suffix:
Gender:F
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:P.O.BOX 1428
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-1428
Mailing Address - Country:US
Mailing Address - Phone:802-362-7512
Mailing Address - Fax:
Practice Address - Street 1:3724 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05254
Practice Address - Country:US
Practice Address - Phone:802-362-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0001092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTPIVN 3008Medicare ID - Type Unspecified