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General NPI Number Information
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NPI Number | 1750429189
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Entity Type | Organization
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Legal Business Name | KDW CHIROCARE INC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 736 BRAWLEY SCHOOL RD SUITE E
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City | MOORESVILLE
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State | NC
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Zip | 28117-9282
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Country | US
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Telephone | 704-664-1031
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Fax | 704-664-1035
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Provider Business Mailing Address
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Address Line | 2275 LAURENS DR
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City | CONCORD
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State | NC
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Zip | 28027-7637
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Country | US
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Telephone | 980-297-1414
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Fax | 704-660-6932
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. KRISTINE MARIE DEBOER
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Credential | D.C.
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Telephone | 980-297-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3509
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License Number State | NC
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