Provider Demographics
NPI:1336271840
Name:KRESSEL, WIN EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:WIN
Middle Name:EDWARD
Last Name:KRESSEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3259 CATLIN AVE
Mailing Address - Street 2:
Mailing Address - City:QUANTICO
Mailing Address - State:VA
Mailing Address - Zip Code:22134-5109
Mailing Address - Country:US
Mailing Address - Phone:703-784-5541
Mailing Address - Fax:
Practice Address - Street 1:2211 E HIGHLAND AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4835
Practice Address - Country:US
Practice Address - Phone:602-955-5170
Practice Address - Fax:602-955-5173
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU75407Medicare UPIN
AZ27656Medicare ID - Type Unspecified