Provider Demographics
NPI:1255968210
Name:PLANINZ, KRISTIN (LAC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:PLANINZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12011 W HONEY DEW DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6983
Mailing Address - Country:US
Mailing Address - Phone:512-734-2104
Mailing Address - Fax:
Practice Address - Street 1:4948 W KOOTENAI ST STE 206
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2082
Practice Address - Country:US
Practice Address - Phone:512-734-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-363171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist