1265665053 NPI number — KATHLEEN LYNN HENNEBERGER D.C.

Table of content: KATHLEEN LYNN HENNEBERGER D.C. (NPI 1265665053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265665053 NPI number — KATHLEEN LYNN HENNEBERGER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENNEBERGER
Provider First Name:
KATHLEEN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OVER
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265665053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
369 DELAWARE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-854-1563
Provider Business Mailing Address Fax Number:
716-854-1567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 LINWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14209-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-400-9462
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  70011732 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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