Basic Information
| Provider Information | |||||||||
| NPI: | 1295947042 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KINTZ CHIROPRACTIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39915 GRAND RIVER AVE | ||||||||
| Address2: | STE 750 | ||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483752153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484767775 | ||||||||
| FaxNumber: | 2484767255 | ||||||||
| Practice Location | |||||||||
| Address1: | 39915 GRAND RIVER AVE | ||||||||
| Address2: | STE 750 | ||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483752153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484767775 | ||||||||
| FaxNumber: | 2484767255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 09/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | KINTZ | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIROPRACTOR | ||||||||
| AuthorizedOfficialTelephone: | 2484767775 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | CK008382 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 0F336810 | 01 | MI | BCBSM | OTHER | 7651352 | 01 | MI | AETNA | OTHER |