Provider Demographics
NPI:1093846743
Name:HALLER, KRISTA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:MARIE
Last Name:HALLER
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 1:470 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-9455
Mailing Address - Country:US
Mailing Address - Phone:716-652-0700
Mailing Address - Fax:
Practice Address - Street 1:470 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-9455
Practice Address - Country:US
Practice Address - Phone:716-652-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11952BMedicare ID - Type Unspecified