Healthcare Provider Details

I. General information

NPI: 1609804863
Provider Name (Legal Business Name): VICTOR ANTHONY KUCHMANER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 S CANFIELD NILES RD BUILDING A, SUITE 103
AUSTINTOWN OH
44515-4077
US

IV. Provider business mailing address

10922 S TRYON ST STE B
CHARLOTTE NC
28273-4152
US

V. Phone/Fax

Practice location:
  • Phone: 330-793-4445
  • Fax: 330-793-1990
Mailing address:
  • Phone: 704-588-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4155
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: