Provider Demographics
NPI:1447345186
Name:WILLIAMSON, KRISTIN M (DC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:M
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-2192
Mailing Address - Country:US
Mailing Address - Phone:515-986-9189
Mailing Address - Fax:515-986-9174
Practice Address - Street 1:206 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-2192
Practice Address - Country:US
Practice Address - Phone:515-986-9189
Practice Address - Fax:515-986-9174
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0263988Medicaid
I4185Medicare ID - Type Unspecified
U86975Medicare UPIN