Provider Demographics
NPI:1215468889
Name:WIMP, KRISTIN (DC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WIMP
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W LA HABRA BLVD
Mailing Address - Street 2:APT. 66
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2915 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2438
Practice Address - Country:US
Practice Address - Phone:310-998-5800
Practice Address - Fax:310-998-5811
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor