Provider Demographics
NPI:1841206935
Name:NOBBE-BLOEMER, KRISTIN ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:NOBBE-BLOEMER
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 1:2136 VADALABENE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5828
Mailing Address - Country:US
Mailing Address - Phone:618-288-5091
Mailing Address - Fax:618-205-3598
Practice Address - Street 1:2136 VADALABENE DR STE B
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5828
Practice Address - Country:US
Practice Address - Phone:618-288-5091
Practice Address - Fax:618-205-3598
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV08719Medicare UPIN
IL213289Medicare ID - Type Unspecified