Provider Demographics
NPI:1477548493
Name:JACOBSEN, KRISTIN A (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:A
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:J
Other - Last Name:ZIPPILLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2230 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301
Mailing Address - Country:US
Mailing Address - Phone:716-282-2225
Mailing Address - Fax:716-284-0162
Practice Address - Street 1:2230 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-2330
Practice Address - Country:US
Practice Address - Phone:716-282-2225
Practice Address - Fax:716-284-0162
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009480111N00000X
PADC010645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350051643OtherRR MEDICARE
16157459602OtherPRISM - UNIVERA ONLY
NY829106OtherEMPIRE INS CO MPN
NY8890408OtherINDEPENDENT HEALTH ASSO
NYBB8194Medicare ID - Type Unspecified