Healthcare Provider Details

I. General information

NPI: 1023334034
Provider Name (Legal Business Name): KINTNER CHIROPRACTIC & SPORT INJURY CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 7TH ST
HARLAN IA
51537-1714
US

IV. Provider business mailing address

1206 7TH ST
HARLAN IA
51537-1714
US

V. Phone/Fax

Practice location:
  • Phone: 712-755-5406
  • Fax: 712-755-5391
Mailing address:
  • Phone: 712-755-5406
  • Fax: 712-755-5391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberA5474
License Number StateIA

VIII. Authorized Official

Name: DR. LARRY KINTNER
Title or Position: PRESIDENT
Credential: DC
Phone: 712-755-5406