Provider Demographics
NPI:1225191182
Name:CHRISTIE, KEVIN MATTHEW II (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MATTHEW
Last Name:CHRISTIE
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 N MILITARY TRL
Mailing Address - Street 2:STE 220
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6308
Mailing Address - Country:US
Mailing Address - Phone:561-859-3109
Mailing Address - Fax:561-988-8993
Practice Address - Street 1:2900 N MILITARY TRL STE 220
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6308
Practice Address - Country:US
Practice Address - Phone:561-997-8898
Practice Address - Fax:561-997-8953
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor