Provider Demographics
NPI:1649375262
Name:KINZER, CHARLES ANTON (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANTON
Last Name:KINZER
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 1:402 RED RIVER AVE N STE 3
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320-1523
Mailing Address - Country:US
Mailing Address - Phone:320-685-8284
Mailing Address - Fax:320-685-3740
Practice Address - Street 1:402 RED RIVER AVE N STE 3
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-1523
Practice Address - Country:US
Practice Address - Phone:320-685-8284
Practice Address - Fax:320-685-3740
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0005527100Medicaid
MN0005527100Medicaid
MNT65710Medicare UPIN