Healthcare Provider Details

I. General information

NPI: 1275612806
Provider Name (Legal Business Name): MARK MICHAEL KUTNER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CENTRAL AVE
DUNKIRK NY
14048-2515
US

IV. Provider business mailing address

510 CENTRAL AVE
DUNKIRK NY
14048-2515
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-5544
  • Fax: 716-366-2512
Mailing address:
  • Phone: 716-366-5544
  • Fax: 716-366-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX002475-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: