Provider Demographics
NPI:1083113559
Name:WEST, KIRSTEN E
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:E
Last Name:WEST
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KIRSTEN
Other - Middle Name:E
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:8500 EXECUTIVE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2225
Mailing Address - Country:US
Mailing Address - Phone:703-698-7117
Mailing Address - Fax:703-698-5729
Practice Address - Street 1:8500 EXECUTIVE PARK AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2225
Practice Address - Country:US
Practice Address - Phone:703-698-7117
Practice Address - Fax:703-698-5729
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557476111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor