Provider Demographics
NPI:1588861330
Name:DEEUGENIO, KRISTIN DRZEWIECKI (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:DRZEWIECKI
Last Name:DEEUGENIO
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 1:73 MONTAGE MOUNTAIN ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507
Mailing Address - Country:US
Mailing Address - Phone:570-800-7991
Mailing Address - Fax:
Practice Address - Street 1:73 MONTAGE MOUNTAIN ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507
Practice Address - Country:US
Practice Address - Phone:570-800-7991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009804111N00000X
NJ38MC00687100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor