Provider Demographics
NPI:1437204260
Name:FAGAN, KRISTOPHER FORREST (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:FORREST
Last Name:FAGAN
Suffix:
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 1:108 MYRTLE RIDGE RD STE B
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-5645
Mailing Address - Country:US
Mailing Address - Phone:813-265-8200
Mailing Address - Fax:813-406-4438
Practice Address - Street 1:108 MYRTLE RIDGE RD STE B
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-5645
Practice Address - Country:US
Practice Address - Phone:813-265-8200
Practice Address - Fax:813-406-4438
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor