Provider Demographics
NPI:1598909228
Name:KLOS-MAKI, KRISTEN LYN (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LYN
Last Name:KLOS-MAKI
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 1:115 WATERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1525
Mailing Address - Country:US
Mailing Address - Phone:218-290-0379
Mailing Address - Fax:
Practice Address - Street 1:115 WATERFRONT DR
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1525
Practice Address - Country:US
Practice Address - Phone:218-290-0379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4467-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor