Provider Demographics
NPI:1902114986
Name:GAINES-PORLIER, KRISTIN ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:GAINES-PORLIER
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 1:2161 W TERRA LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2366
Mailing Address - Country:US
Mailing Address - Phone:636-887-3400
Mailing Address - Fax:
Practice Address - Street 1:2161 W TERRA LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2366
Practice Address - Country:US
Practice Address - Phone:636-887-3400
Practice Address - Fax:636-887-3434
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010028196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor