Provider Demographics
NPI:1518117746
Name:DEARBORN, KRISTINE MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:MICHELLE
Last Name:DEARBORN
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 1:1107 NW STATION PLACE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:503-626-3700
Mailing Address - Fax:503-643-6667
Practice Address - Street 1:1107 NW STATION PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6690
Practice Address - Country:US
Practice Address - Phone:503-626-3700
Practice Address - Fax:503-643-6667
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor