Provider Demographics
NPI:1609635945
Name:CASTILLON, KRISTEN DOMINIQUE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:DOMINIQUE
Last Name:CASTILLON
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 1:711 NE 117TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-3940
Mailing Address - Country:US
Mailing Address - Phone:909-234-9370
Mailing Address - Fax:
Practice Address - Street 1:3241 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1814
Practice Address - Country:US
Practice Address - Phone:503-282-8582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor