Provider Demographics
NPI:1225006216
Name:FENDEL, KRISTIN KAE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:KAE
Last Name:FENDEL
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 1:111 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-5637
Mailing Address - Country:US
Mailing Address - Phone:510-329-1482
Mailing Address - Fax:208-585-6431
Practice Address - Street 1:111 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-5637
Practice Address - Country:US
Practice Address - Phone:208-899-2856
Practice Address - Fax:208-585-6431
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13513111N00000X
IDCHIA-1807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0135130Medicare ID - Type Unspecified