Provider Demographics
NPI:1861797706
Name:ROBISON, DIERDRA KRISTEN (DC)
Entity type:Individual
Prefix:DR
First Name:DIERDRA
Middle Name:KRISTEN
Last Name:ROBISON
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 1:2144 DECLARATION DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-7034
Mailing Address - Country:US
Mailing Address - Phone:859-815-9371
Mailing Address - Fax:859-356-0686
Practice Address - Street 1:2144 DECLARATION DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-7034
Practice Address - Country:US
Practice Address - Phone:859-815-9371
Practice Address - Fax:859-356-0686
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor