Provider Demographics
NPI:1245405018
Name:KOSTELECKY, CHRISTINA MARGARET (DC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARGARET
Last Name:KOSTELECKY
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 1:1428 W VILLARD ST
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4648
Mailing Address - Country:US
Mailing Address - Phone:701-483-8855
Mailing Address - Fax:701-483-6916
Practice Address - Street 1:1428 W VILLARD ST
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4648
Practice Address - Country:US
Practice Address - Phone:701-483-8855
Practice Address - Fax:701-483-6916
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND814111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor