Provider Demographics
NPI:1215327929
Name:SUNDBERG, KRISTIN ELIZABETH (LAC, MAOM)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:SUNDBERG
Suffix:
Gender:F
Credentials:LAC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6503B CANNONLEAGUE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4917
Mailing Address - Country:US
Mailing Address - Phone:512-632-4973
Mailing Address - Fax:512-233-0744
Practice Address - Street 1:1609 NUECES ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1105
Practice Address - Country:US
Practice Address - Phone:512-632-4973
Practice Address - Fax:512-233-0744
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01143171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist