Active NPI
Kristen Ann Kaczanowski, DC
- Chiropractor
- Bridgeport, CT
National Provider Identifier
1104073220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1076CT
- Practice address
- 1115 Main Street
Suite #412
Bridgeport, CT 06604-4406 - Phone
- (203) 335-7260
- Fax
- (203) 335-2561
- NPI assigned
- Aug 20, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1076CT | CT | Primary |
Addresses
Primary practice location
1115 Main Street
Suite #412
Bridgeport, CT 06604-4406
Mailing address
1115 Main Street
Suite #412
Bridgeport, CT 06604-4406
Phone (203) 335-7260
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 050001076CT03 | Other | CT | BC/BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1076CT | CT | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219190400000",
"number": "1104073220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 MAIN STREET",
"address_2": "SUITE #412",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066044406",
"telephone_number": "203-335-7260",
"fax_number": "203-335-2561"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1115 MAIN STREET",
"address_2": "SUITE #412",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066044406",
"telephone_number": "203-335-7260",
"fax_number": "203-335-2561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KACZANOWSKI",
"first_name": "KRISTEN",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-20",
"last_updated": "2008-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CT",
"license": "1076CT",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "050001076CT03",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.