Provider Demographics
NPI:1225318298
Name:MAHAN-SAWVELL, KRISTINA MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:MICHELLE
Last Name:MAHAN-SAWVELL
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:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-0194
Mailing Address - Country:US
Mailing Address - Phone:360-829-0610
Mailing Address - Fax:360-829-6354
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321-0194
Practice Address - Country:US
Practice Address - Phone:360-829-0610
Practice Address - Fax:360-829-6354
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60212280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor