=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790940765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VAN ZEILEN FAMILY CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2008
-----------------------------------------------------
Last Update Date | 07/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 LATONA ROAD SUITE 404
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14626-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-227-8290
-----------------------------------------------------
Fax | 585-227-5385
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 LATONA ROAD SUITE 404
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-227-8290
-----------------------------------------------------
Fax | 585-227-5385
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. KRIS DANIEL VAN ZEILEN
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 585-227-8290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X011182-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------