Provider Demographics
NPI:1184040602
Name:IBANEZ, KRISTIN (DC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:IBANEZ
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 1:8680 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4804
Mailing Address - Country:US
Mailing Address - Phone:305-393-4838
Mailing Address - Fax:
Practice Address - Street 1:8680 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-4804
Practice Address - Country:US
Practice Address - Phone:305-393-4838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11143111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor