Individual provider Active NPI

Stephanie Ann Kinik, D.C.

  • Chiropractor
  • Fairfield, CT
National Provider Identifier
1245338037
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1410 Issued in CT
Practice address
2000 Post Rd
Ste 203
Fairfield, CT 06824-5730
Phone
(203) 259-1555
Fax
(203) 254-2417
NPI assigned
Sep 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1410 CT Primary

Addresses

Primary practice location

2000 Post Rd
Ste 203
Fairfield, CT 06824-5730

Mailing address

148 E Village Rd
Shelton, CT 06484-1778
Phone (203) 929-1504

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041129000210 CT Practitioner - Chiropractic 2062477318 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

555 Bridgeport Ave
Shelton, CT 06484-4892
Phone (203) 225-9977

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1410CTMDBehavioral Analyst
001410CTMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Wellness Center, LLC Chiropractor CurrentSince Mar 1, 2008 Accepting new patients
Respiratory Associates PC Past Accepting new patients

Locations

555 Bridgeport Ave
Shelton, CT 06484
Phone (203) 550-2755

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1245338037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 E VILLAGE RD",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064841778",
            "telephone_number": "203-929-1504",
            "fax_number": "203-929-1504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 POST RD",
            "address_2": "STE 203",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245730",
            "telephone_number": "203-259-1555",
            "fax_number": "203-254-2417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINIK",
        "first_name": "STEPHANIE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CT",
            "license": "1410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.