Provider Demographics
NPI:1114933454
Name:CARPENTER, KRISTA KATHLEEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:KATHLEEN
Last Name:CARPENTER
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 1:6410 ALPINE AVE NW
Mailing Address - Street 2:SUITE C
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-8001
Mailing Address - Country:US
Mailing Address - Phone:616-785-7970
Mailing Address - Fax:616-785-7973
Practice Address - Street 1:6410 ALPINE AVE NW
Practice Address - Street 2:SUITE C
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-8001
Practice Address - Country:US
Practice Address - Phone:616-785-7970
Practice Address - Fax:616-785-7973
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU62709Medicare UPIN
MI0M28340Medicare ID - Type UnspecifiedMEDICARE ID NUMBER