Provider Demographics
NPI:1447591904
Name:SIMONSEN, KRISTINA MICHELE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:MICHELE
Last Name:SIMONSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:MICHELE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:17 1ST AVE NW
Mailing Address - Street 2:STE A
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3511
Mailing Address - Country:US
Mailing Address - Phone:712-546-8151
Mailing Address - Fax:712-546-7653
Practice Address - Street 1:200 5TH AVE NW
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3116
Practice Address - Country:US
Practice Address - Phone:712-546-8151
Practice Address - Fax:712-546-7653
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010077111N00000X
IA082634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor