Provider Demographics
NPI:1689609018
Name:COUSINEAU, KRISTIN J (DC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:J
Last Name:COUSINEAU
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 1:14550 KING RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7963
Mailing Address - Country:US
Mailing Address - Phone:734-479-1880
Mailing Address - Fax:734-479-4810
Practice Address - Street 1:14550 KING RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7963
Practice Address - Country:US
Practice Address - Phone:734-479-1880
Practice Address - Fax:734-479-4810
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKC009141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
9506227980OtherBLUECROSS
MI30000001T2G0EAKOtherWRITE PAD OCN CERTIFICATION
9506227980OtherBLUECROSS
MI30000001T2G0EAKOtherWRITE PAD OCN CERTIFICATION