Provider Demographics
NPI:1831112366
Name:KINSELLA, KRIS GERARD (DC)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:GERARD
Last Name:KINSELLA
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 1:4501 MISSION BAY DR STE 2D
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4925
Mailing Address - Country:US
Mailing Address - Phone:858-581-1828
Mailing Address - Fax:
Practice Address - Street 1:4501 MISSION BAY DR STE 2D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4925
Practice Address - Country:US
Practice Address - Phone:858-581-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28570111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC28570AMedicare ID - Type Unspecified
CAU95233Medicare UPIN
CAW18822Medicare ID - Type Unspecified