Healthcare Provider Details

I. General information

NPI: 1780778944
Provider Name (Legal Business Name): MARC DAVID KIRSHNER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 SUMMER ST
STAMFORD CT
06905-5016
US

IV. Provider business mailing address

423 ROCK RIMMON RD
STAMFORD CT
06903-2818
US

V. Phone/Fax

Practice location:
  • Phone: 203-975-7000
  • Fax: 203-975-0876
Mailing address:
  • Phone: 203-461-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number000952
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: