Provider Demographics
NPI:1790870434
Name:MAGGS, KRISTINE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:
Last Name:MAGGS
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 1:5551 TOURNAMENT DR
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-3101
Mailing Address - Country:US
Mailing Address - Phone:703-477-6174
Mailing Address - Fax:
Practice Address - Street 1:5551 TOURNAMENT DR
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-3101
Practice Address - Country:US
Practice Address - Phone:703-477-6174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV3560A283OtherPTAN
VAU68306Medicare UPIN