Provider Demographics
NPI:1831474527
Name:ADDISON, KIRSTEN D (DC)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:D
Last Name:ADDISON
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 1:812 ARCH LN SW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-8852
Mailing Address - Country:US
Mailing Address - Phone:218-368-5087
Mailing Address - Fax:
Practice Address - Street 1:403 AMERICA AVE NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3122
Practice Address - Country:US
Practice Address - Phone:218-444-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4641111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor