Healthcare Provider Details

I. General information

NPI: 1467488973
Provider Name (Legal Business Name): KIRSTEN LIWANAG D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 7TH ST SUITE 1
GRAND JUNCTION CO
81501-3062
US

IV. Provider business mailing address

1300 N 7TH ST SUITE 1
GRAND JUNCTION CO
81501-3062
US

V. Phone/Fax

Practice location:
  • Phone: 970-241-6366
  • Fax: 970-245-5619
Mailing address:
  • Phone: 970-241-6366
  • Fax: 970-245-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5655
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: