MEDICARE: DR. KRISTIE E FONG DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR008032	GA
2	111N00000X	Chiropractor	DC29880	CA

General Provider Information

NPI Number	:	1952499766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIE E FONG DC

Provider Business Mailing Address
First Line	:	1032 IRVING ST
Second Line	:	103
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-2216
Country	:	US
Telephone Number	:	415-722-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	2535 JUDAH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1437
Country	:	US
Telephone Number	:	415-722-2555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	09/25/2013

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