Provider Demographics
NPI:1528499050
Name:SIETSEMA, KENDRA (DC)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:
Last Name:SIETSEMA
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 1:4463 OHIO ST APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4396
Mailing Address - Country:US
Mailing Address - Phone:612-889-9722
Mailing Address - Fax:
Practice Address - Street 1:272 N EL CAMINO REAL STE C
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2857
Practice Address - Country:US
Practice Address - Phone:612-889-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5847111N00000X
CA34724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor