Provider Demographics
NPI:1184863318
Name:BREW, KRISTINE KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:KAY
Last Name:BREW
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 1:3110 CAMINO DEL RIO S STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3832
Mailing Address - Country:US
Mailing Address - Phone:619-299-9722
Mailing Address - Fax:858-278-7055
Practice Address - Street 1:3110 CAMINO DEL RIO S STE 310
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3832
Practice Address - Country:US
Practice Address - Phone:619-299-9722
Practice Address - Fax:858-278-7055
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC31109Medicare UPIN