Provider Demographics
NPI:1811551906
Name:WILLIFORD, KRISTEN (DC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:WILLIFORD
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 1:2929 LONESOME DOVE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-8025
Mailing Address - Country:US
Mailing Address - Phone:301-471-1624
Mailing Address - Fax:
Practice Address - Street 1:1425 LIGHT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4514
Practice Address - Country:US
Practice Address - Phone:410-752-2330
Practice Address - Fax:410-837-1595
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS04010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor