Healthcare Provider Details

I. General information

NPI: 1285683334
Provider Name (Legal Business Name): KRIS A KINSLEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 BROAD ST
WAVERLY NY
14892-1502
US

IV. Provider business mailing address

551 BROAD ST
WAVERLY NY
14892-1502
US

V. Phone/Fax

Practice location:
  • Phone: 607-565-9212
  • Fax:
Mailing address:
  • Phone: 607-565-9212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberXO04945-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: