Provider Demographics
NPI:1205885720
Name:SCHICK, KIRSTEN AAEN (DC)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:AAEN
Last Name:SCHICK
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 1:3725 LONE TREE WAY
Mailing Address - Street 2:D-3
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6064
Mailing Address - Country:US
Mailing Address - Phone:925-777-3336
Mailing Address - Fax:925-777-3399
Practice Address - Street 1:3725 LONE TREE WAY
Practice Address - Street 2:D-3
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6064
Practice Address - Country:US
Practice Address - Phone:925-777-3336
Practice Address - Fax:925-777-3399
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6743436Medicaid
CADC21119OtherLICENSE
CADC0211191Medicare PIN
CA6743436Medicaid