Provider Demographics
NPI:1871574137
Name:WEBER, KRISTEN (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:331 COTUIT RD
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2434
Mailing Address - Country:US
Mailing Address - Phone:508-833-0410
Mailing Address - Fax:508-888-4007
Practice Address - Street 1:331 COTUIT RD
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2434
Practice Address - Country:US
Practice Address - Phone:508-833-0410
Practice Address - Fax:508-888-4007
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA351970OtherHARVARD PILGRIM HEALTHCAR
MA5547065OtherCCN
MA1600231Medicaid
MAY36898OtherBCBS OF MA
MA351970OtherFIRST HEALTH
MA5547065OtherCCN
MAY36898OtherBCBS OF MA
MAU91014Medicare UPIN