Provider Demographics
NPI:1770781213
Name:BODENBENDER, KRISTIN M (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:M
Last Name:BODENBENDER
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 1:2850 MESA VERDE DR E
Mailing Address - Street 2:SUITE K
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4891
Mailing Address - Country:US
Mailing Address - Phone:714-434-2585
Mailing Address - Fax:866-390-2850
Practice Address - Street 1:2850 MESA VERDE DR E
Practice Address - Street 2:SUITE K
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4891
Practice Address - Country:US
Practice Address - Phone:714-434-2585
Practice Address - Fax:866-390-2850
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24289111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66768ZOtherBLUE SHIELD
CADC24289OtherCHIROPRACTIC LICENSE
CA1437478237OtherGROUP NPI