Provider Demographics
NPI:1710309976
Name:KAISER, KRYSTINE MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:KRYSTINE
Middle Name:MICHELLE
Last Name:KAISER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KRYSTINE
Other - Middle Name:MICHELLE
Other - Last Name:MESCHKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:328 HERITAGE PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5251
Mailing Address - Country:US
Mailing Address - Phone:507-332-0202
Mailing Address - Fax:507-332-2206
Practice Address - Street 1:328 HERITAGE PL
Practice Address - Street 2:SUITE A
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5251
Practice Address - Country:US
Practice Address - Phone:507-332-0202
Practice Address - Fax:507-332-2206
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor