Provider Demographics
NPI:1245786029
Name:KARSTU, ELISSA
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:KARSTU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BAGLEY ST APT 1024
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-1326
Mailing Address - Country:US
Mailing Address - Phone:906-231-1979
Mailing Address - Fax:
Practice Address - Street 1:600 TOWER LEVEL 1
Practice Address - Street 2:RENAISSANCE CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48243
Practice Address - Country:US
Practice Address - Phone:313-393-7995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008711111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation