Provider Demographics
NPI:1609050954
Name:IPEN VAN ZEILEN, KRISTOPHER DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:DANIEL
Last Name:IPEN VAN ZEILEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KRISTOPHER
Other - Middle Name:DANIEL
Other - Last Name:VAN ZEILEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:550 LATONA RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2700
Mailing Address - Country:US
Mailing Address - Phone:585-227-8290
Mailing Address - Fax:585-227-5385
Practice Address - Street 1:550 LATONA RD
Practice Address - Street 2:SUITE 404
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2700
Practice Address - Country:US
Practice Address - Phone:585-227-8290
Practice Address - Fax:585-227-5385
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011182-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor