Provider Demographics
NPI:1992853295
Name:KINSELLA, TIMOTHY RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RYAN
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 1:407 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN296M4KIOtherBCBS
MN412129056OtherHSM PONE
MN411508205OtherSELECTCARE
MN934613900OtherPRIMEWEST
MN412129056OtherFEDERAL TAX ID
MN934613900Medicaid
MN934613900OtherPRIMEWEST
MN412129056OtherFEDERAL TAX ID