Organization
KENSINGTON VALLEY ORTHOTIC & SPORTS SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL QUENTIN MINERT C.O. (PRESIDENT/OWNER)
(810) 231-6905
Entity
Organization
Contact information
Practice address
10020 PROFESSIONAL CANTER DR., HAMBURG, MI 48139-0215
(810) 231-6905
(810) 231-6906
Mailing address
PO BOX 215, HAMBURG, MI 48139-0215
(810) 231-6905
(801) 231-6906
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4489299
—
MI
01
—
510D703120
BLUE CROSS BLUE SHIELD MI
MI
Enumeration date
02/21/2006
Last updated
04/13/2011
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