Provider Demographics
NPI:1366566234
Name:KINUM, EDWARD ALBERT III (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALBERT
Last Name:KINUM
Suffix:III
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 1:201 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-2126
Mailing Address - Country:US
Mailing Address - Phone:518-382-0055
Mailing Address - Fax:518-382-0099
Practice Address - Street 1:201 GLEN AVE
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-2126
Practice Address - Country:US
Practice Address - Phone:518-382-0055
Practice Address - Fax:518-382-0099
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor