Provider Demographics
NPI:1861520397
Name:KINTNER CHIROPRACTIC CENTER, PC
Entity type:Organization
Organization Name:KINTNER CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KINTNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, DC
Authorized Official - Phone:802-899-5400
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-0063
Mailing Address - Country:US
Mailing Address - Phone:802-899-5400
Mailing Address - Fax:
Practice Address - Street 1:397 VT ROUTE 15
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-2044
Practice Address - Country:US
Practice Address - Phone:802-899-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT06834111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00028821OtherBCBSVT GROUP
VT00009924OtherBCBSVT PROVIDER
VT00009924OtherBCBSVT PROVIDER