Provider Demographics
NPI:1114636453
Name:HUBER, KRYSTA (DC)
Entity Type:Individual
Prefix:
First Name:KRYSTA
Middle Name:
Last Name:HUBER
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 1:7340 SW HUNZIKER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2303
Mailing Address - Country:US
Mailing Address - Phone:503-624-7249
Mailing Address - Fax:
Practice Address - Street 1:7340 SW HUNZIKER RD STE 101
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2303
Practice Address - Country:US
Practice Address - Phone:503-624-7249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor