Provider Demographics
NPI:1912336983
Name:HOLMBERG, KRIS ANN
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:ANN
Last Name:HOLMBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:KRISTINE
Other - Middle Name:ANN
Other - Last Name:HOLMBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:29 PURITAN RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2229
Mailing Address - Country:US
Mailing Address - Phone:617-794-0043
Mailing Address - Fax:
Practice Address - Street 1:29 PURITAN RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2229
Practice Address - Country:US
Practice Address - Phone:617-794-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor