Healthcare Provider Details

I. General information

NPI: 1104811975
Provider Name (Legal Business Name): BRETT LAWRENCE KINSLER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2364 LYELL AVE LYELL HOWARD COMMONS
ROCHESTER NY
14606-5738
US

IV. Provider business mailing address

2364 LYELL AVE
ROCHESTER NY
14606-5738
US

V. Phone/Fax

Practice location:
  • Phone: 585-429-5100
  • Fax: 585-429-5101
Mailing address:
  • Phone: 585-429-5100
  • Fax: 585-429-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX00085177B
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: