Provider Demographics
NPI:1780858704
Name:TIMOTHY R. KINSELLA DC PLLC
Entity Type:Organization
Organization Name:TIMOTHY R. KINSELLA DC PLLC
Other - Org Name:KINSELLA CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:KINSELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-593-4494
Mailing Address - Street 1:407 S SIBLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-3027
Mailing Address - Country:US
Mailing Address - Phone:320-593-4494
Mailing Address - Fax:320-593-4495
Practice Address - Street 1:407 S SIBLEY AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-3027
Practice Address - Country:US
Practice Address - Phone:320-593-4494
Practice Address - Fax:320-593-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6889497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN934613900Medicaid
MNC03508Medicare PIN
MN934613900Medicaid