Provider Demographics
NPI:1952499766
Name:FONG, KRISTIE E (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:E
Last Name:FONG
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 1:1032 IRVING ST
Mailing Address - Street 2:103
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2216
Mailing Address - Country:US
Mailing Address - Phone:415-722-2555
Mailing Address - Fax:
Practice Address - Street 1:2535 JUDAH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1437
Practice Address - Country:US
Practice Address - Phone:415-722-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008032111N00000X
CADC29880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor