Provider Demographics
NPI:1669757332
Name:ROBINSON, KIERAH K (DN, LMT, RDH)
Entity type:Individual
Prefix:DR
First Name:KIERAH
Middle Name:K
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:DN, LMT, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 E 53RD ST STE 810
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4578
Mailing Address - Country:US
Mailing Address - Phone:773-587-0182
Mailing Address - Fax:
Practice Address - Street 1:5305 S HARPER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4506
Practice Address - Country:US
Practice Address - Phone:773-587-0182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020009052124Q00000X
IL227010183225700000X
IL181000404172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath
No124Q00000XDental ProvidersDental Hygienist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist