Provider Demographics
NPI:1831239987
Name:FAVREAU, KRISTEN N (DC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:FAVREAU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:N
Other - Last Name:KROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:178 ST GEORGE STREET
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332
Mailing Address - Country:US
Mailing Address - Phone:781-934-5114
Mailing Address - Fax:781-934-9114
Practice Address - Street 1:178 ST GEORGE STREET
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332
Practice Address - Country:US
Practice Address - Phone:781-934-5114
Practice Address - Fax:781-934-9114
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor