Provider Demographics
NPI:1497861132
Name:KINTZEL, LORI DANIELLE (DC)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:DANIELLE
Last Name:KINTZEL
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 1:888 W GALENA AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-3974
Mailing Address - Country:US
Mailing Address - Phone:815-616-8424
Mailing Address - Fax:
Practice Address - Street 1:888 W GALENA AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-3974
Practice Address - Country:US
Practice Address - Phone:815-616-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009222111N00000X
IL038012012111N00000X
IA007392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor