Provider Demographics
NPI:1699594465
Name:KRISTIN KUKENBERGER DBA KUKENBERGER CHIROPRACTIC
Entity type:Organization
Organization Name:KRISTIN KUKENBERGER DBA KUKENBERGER CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUKENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-314-3900
Mailing Address - Street 1:7000 E GENESEE ST BLDG C
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1131
Mailing Address - Country:US
Mailing Address - Phone:315-314-3900
Mailing Address - Fax:
Practice Address - Street 1:7000 E GENESEE ST BLDG C
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1131
Practice Address - Country:US
Practice Address - Phone:315-314-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty