Provider Demographics
NPI:1033421532
Name:TATAREK, KRYSTEN (DC)
Entity Type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:
Last Name:TATAREK
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 1:2511 W MOFFAT ST
Mailing Address - Street 2:APT 102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4388
Mailing Address - Country:US
Mailing Address - Phone:773-782-7410
Mailing Address - Fax:
Practice Address - Street 1:4045 N DAMEN AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3277
Practice Address - Country:US
Practice Address - Phone:773-296-2766
Practice Address - Fax:773-296-2768
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011455111NN0400X, 111NN1001X, 111NR0200X, 111NR0400X, 111NS0005X, 111NX0100X, 111NX0800X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
No111NX0800XChiropractic ProvidersChiropractorOrthopedic