Provider Demographics
NPI:1851469258
Name:MOYNIHAN, KIMBERLY KOZIK (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KOZIK
Last Name:MOYNIHAN
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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027-0126
Mailing Address - Country:US
Mailing Address - Phone:518-384-2223
Mailing Address - Fax:518-384-3273
Practice Address - Street 1:110 LAKE HILL RD
Practice Address - Street 2:
Practice Address - City:BURNT HILLS
Practice Address - State:NY
Practice Address - Zip Code:12027-9516
Practice Address - Country:US
Practice Address - Phone:518-384-2223
Practice Address - Fax:518-384-3273
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009255-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMBB6959Medicare ID - Type UnspecifiedPAR PROVIDER NUMBER