Provider Demographics
NPI:1679759385
Name:KOLESAR FABRIS, KRISTIN (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:KOLESAR FABRIS
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 1:255 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2261
Mailing Address - Country:US
Mailing Address - Phone:401-337-5684
Mailing Address - Fax:401-337-9290
Practice Address - Street 1:255 HOPE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2261
Practice Address - Country:US
Practice Address - Phone:401-337-5684
Practice Address - Fax:401-337-9290
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3464OtherMA CHIROPRACTIC LICENSE
RIDCP00564OtherRI CHIROPRACTIC LICENSE