Provider Demographics
NPI:1134292279
Name:DEBOER, KRISTINE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:MARIE
Last Name:DEBOER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KRISTINE
Other - Middle Name:MARIE
Other - Last Name:DEBOER-WEILAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 3363
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-3363
Mailing Address - Country:US
Mailing Address - Phone:704-664-1031
Mailing Address - Fax:704-664-1035
Practice Address - Street 1:127 PROMENADE DR STE D
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6891
Practice Address - Country:US
Practice Address - Phone:704-664-1031
Practice Address - Fax:704-664-1035
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor