Provider Demographics
NPI:1497820856
Name:KIERSTYN, SUNNY (RN,DC)
Entity Type:Individual
Prefix:DR
First Name:SUNNY
Middle Name:
Last Name:KIERSTYN
Suffix:
Gender:F
Credentials:RN,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4113
Mailing Address - Country:US
Mailing Address - Phone:541-654-0850
Mailing Address - Fax:541-654-0834
Practice Address - Street 1:1663 HIGH ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4113
Practice Address - Country:US
Practice Address - Phone:541-654-0850
Practice Address - Fax:541-654-0834
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3035111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101078Medicare ID - Type Unspecified
OR203331921OtherLLC #