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General NPI Number Information
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NPI Number | 1821129529
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Entity Type | Organization
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Legal Business Name | DR. KIERSTYN LLC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 2677 WILLAKENZIE RD 7C
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City | EUGENE
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State | OR
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Zip | 97401-4873
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Country | US
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Telephone | 541-344-0509
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Fax | 541-344-0955
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Provider Business Mailing Address
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Address Line | 2677 WILLAKENZIE RD 7C
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City | EUGENE
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State | OR
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Zip | 97401-4873
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Country | US
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Telephone | 541-344-0509
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Fax | 541-344-0955
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Authorized Official
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Title or Position | CEO
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Name | DR. S KIERSTYN
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Credential | RN DC LLC
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Telephone | 541-344-0509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 27 3035
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License Number State | OR
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