Provider Demographics
NPI:1669571527
Name:KISSEL, STEPHEN CHARLES (DC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHARLES
Last Name:KISSEL
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 1:64 BLOOD ST
Mailing Address - Street 2:
Mailing Address - City:LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-3514
Mailing Address - Country:US
Mailing Address - Phone:806-434-3176
Mailing Address - Fax:
Practice Address - Street 1:314 FLANDERS RD
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1727
Practice Address - Country:US
Practice Address - Phone:860-739-3600
Practice Address - Fax:860-739-3601
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor