Provider Demographics
NPI:1881105252
Name:DEARMOND, KRISTIN (DC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:DEARMOND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:DEHAAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7051 CYPRESS TER
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8822
Mailing Address - Country:US
Mailing Address - Phone:239-886-3066
Mailing Address - Fax:
Practice Address - Street 1:7051 CYPRESS TER
Practice Address - Street 2:STE 106
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-8801
Practice Address - Country:US
Practice Address - Phone:239-886-3066
Practice Address - Fax:239-887-3074
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1114143708OtherMEDICARE