Provider Demographics
NPI:1871036285
Name:NIELSEN, KRISTINA (DC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:NIELSEN
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 1:421 W RIVERSIDE AVE STE 711
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0402
Mailing Address - Country:US
Mailing Address - Phone:509-844-2226
Mailing Address - Fax:
Practice Address - Street 1:421 W RIVERSIDE AVE
Practice Address - Street 2:SUITE 711
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0405
Practice Address - Country:US
Practice Address - Phone:509-844-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60693516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor