Doctor Name: | DR. STACEY MARIE KISTING |
NPI Number: | 1093896094 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DC |
License Number: | |
Business Practice Address: | 3450 38th Ave Ste 4 Moline, IL - 612656409 |
Business Phone Number: | 3097647200 |
Business Fax Number: | 3097647750 |
Mailing Address: | 5313 11th Avenue B, MOLINE |
State: | IL |
Postal Code: | 612652866 |
Phone Number: | 3097647200 |
Fax Number: | 3097647750 |
NPI Enumeration Date: | 10/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |