Provider Demographics
NPI:1023862950
Name:ROMAN, KRISTIAN (DR OF CHIROPRACTIC)
Entity type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:
Last Name:ROMAN
Suffix:
Gender:M
Credentials:DR OF CHIROPRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3949 EVANS AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9345
Mailing Address - Country:US
Mailing Address - Phone:239-288-7274
Mailing Address - Fax:
Practice Address - Street 1:3949 EVANS AVE STE 406
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9345
Practice Address - Country:US
Practice Address - Phone:239-288-7274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor