Provider Demographics
NPI:1225331994
Name:IMAN, KRISTEN MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:MARIE
Last Name:IMAN
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 1:305 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4218
Mailing Address - Country:US
Mailing Address - Phone:410-749-6672
Mailing Address - Fax:410-860-5387
Practice Address - Street 1:305 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4218
Practice Address - Country:US
Practice Address - Phone:410-749-6672
Practice Address - Fax:410-860-5387
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor