Provider Demographics
NPI:1750429189
Name:KDW CHIROCARE INC
Entity type:Organization
Organization Name:KDW CHIROCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DEBOER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:980-297-1414
Mailing Address - Street 1:2275 LAURENS DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7637
Mailing Address - Country:US
Mailing Address - Phone:980-297-1414
Mailing Address - Fax:704-660-6932
Practice Address - Street 1:736 BRAWLEY SCHOOL RD
Practice Address - Street 2:SUITE E
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9282
Practice Address - Country:US
Practice Address - Phone:704-664-1031
Practice Address - Fax:704-664-1035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL CHIROPRACTIC CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-01
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2459637BOtherMEDICARE
NC1750429189OtherGROUP NPI
NC2459637AOtherGROUP MEDICARE