Provider Demographics
NPI:1891822698
Name:FELLOWS, KRISTIN M (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:M
Last Name:FELLOWS
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 1:1590 THOMAS CENTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2578
Mailing Address - Country:US
Mailing Address - Phone:651-209-9710
Mailing Address - Fax:
Practice Address - Street 1:1590 THOMAS CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2578
Practice Address - Country:US
Practice Address - Phone:651-209-9710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2009-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350004414Medicare PIN