Provider Demographics
NPI:1043587827
Name:CRIST, CARRY R (DC,)
Entity Type:Individual
Prefix:DR
First Name:CARRY
Middle Name:R
Last Name:CRIST
Suffix:
Gender:M
Credentials:DC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 W ROCA RD
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-5027
Mailing Address - Country:US
Mailing Address - Phone:402-826-5097
Mailing Address - Fax:402-826-2892
Practice Address - Street 1:12100 W ROCA RD
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-5027
Practice Address - Country:US
Practice Address - Phone:402-826-5097
Practice Address - Fax:402-826-2892
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor