Provider Demographics
NPI:1922371913
Name:BACKENSTOSE, KRISTINA NOEL (DC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:NOEL
Last Name:BACKENSTOSE
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 1:3335 COBB PKWY NW STE 230
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8361
Mailing Address - Country:US
Mailing Address - Phone:678-594-3119
Mailing Address - Fax:
Practice Address - Street 1:3335 COBB PKWY NW STE 230
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8361
Practice Address - Country:US
Practice Address - Phone:678-594-3119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008896111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition