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General NPI Number Information
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NPI Number | 1265665053
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Entity Type | Individual
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Provider Name | KATHLEEN LYNN HENNEBERGER D.C.
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Gender | Female
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 196 LINWOOD AVE
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City | BUFFALO
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State | NY
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Zip | 14209-2010
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Country | US
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Telephone | 716-400-9462
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Fax |
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Provider Business Mailing Address
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Address Line | 369 DELAWARE AVENUE
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City | BUFFALO
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State | NY
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Zip | 14202
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Country | US
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Telephone | 716-854-1563
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Fax | 716-854-1567
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 70011732
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License Number State | NY
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