Provider Demographics
NPI:1912121583
Name:KIRSTEN, DENNIS WILLIAM (DC, NP-C)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:WILLIAM
Last Name:KIRSTEN
Suffix:
Gender:M
Credentials:DC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 RAILROAD SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-774-3997
Mailing Address - Fax:928-774-3998
Practice Address - Street 1:1750 RAILROAD SPRINGS BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-774-3997
Practice Address - Fax:928-774-3998
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2015-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3914111N00000X
NM1558111N00000X
AZAP8327363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ13499OtherHMA
AZAZ0937390OtherBLUE CROSS BLUE SHIELD
NMNM00KJ71OtherBLUE CROSS BLUE SHIELD
AZZ-102832Medicare ID - Type Unspecified