Provider Demographics
NPI:1518148139
Name:KIDWELL-MINX, CHRISTINE RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:RENEE
Last Name:KIDWELL-MINX
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 1:8200 S SAGINAW ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1843
Mailing Address - Country:US
Mailing Address - Phone:810-603-1497
Mailing Address - Fax:810-603-1498
Practice Address - Street 1:8200 S SAGINAW ST
Practice Address - Street 2:SUITE 600
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1843
Practice Address - Country:US
Practice Address - Phone:810-603-1497
Practice Address - Fax:810-603-1498
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P57680OtherMEDICARE PTAN