Healthcare Provider Details

I. General information

NPI: 1336271840
Provider Name (Legal Business Name): WIN EDWARD KRESSEL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 E HIGHLAND AVE SUITE 110
PHOENIX AZ
85016-4835
US

IV. Provider business mailing address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

V. Phone/Fax

Practice location:
  • Phone: 602-955-5170
  • Fax: 602-955-5173
Mailing address:
  • Phone: 703-784-5541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5452
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: