Provider Demographics
NPI:1881266823
Name:FOULLONG, KIRSTEN (DC)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:FOULLONG
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 1:3734 IROQUOIS AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-5231
Mailing Address - Country:US
Mailing Address - Phone:619-724-9533
Mailing Address - Fax:
Practice Address - Street 1:8450 COOPER CREEK BLVD STE 104
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-2018
Practice Address - Country:US
Practice Address - Phone:941-822-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13596111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor