Provider Demographics
NPI:1043585284
Name:KIP, KRISTA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:ANN
Last Name:KIP
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4792 CAUGHLIN PKWY STE 207
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0911
Mailing Address - Country:US
Mailing Address - Phone:775-828-9665
Mailing Address - Fax:775-828-7605
Practice Address - Street 1:4792 CAUGHLIN PKWY STE 207
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-0911
Practice Address - Country:US
Practice Address - Phone:775-828-9665
Practice Address - Fax:775-828-7605
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor