Provider Demographics
NPI:1295721025
Name:NIEMYNSKI, KRISTINA MARIE (DC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:NIEMYNSKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:NIEMYNSKI-COUCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:345 REEVE AVE
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-3545
Mailing Address - Country:US
Mailing Address - Phone:631-298-5253
Mailing Address - Fax:631-298-7227
Practice Address - Street 1:345 REEVE AVE
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952-3545
Practice Address - Country:US
Practice Address - Phone:631-298-5253
Practice Address - Fax:631-298-7227
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U32007Medicare UPIN
NYX48401Medicare ID - Type Unspecified