Provider Demographics
NPI:1275529745
Name:NEIFERT, KRISTON SHANE (DC)
Entity Type:Individual
Prefix:
First Name:KRISTON
Middle Name:SHANE
Last Name:NEIFERT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12401 OLIVE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5448
Mailing Address - Country:US
Mailing Address - Phone:314-576-1495
Mailing Address - Fax:314-576-2804
Practice Address - Street 1:12401 OLIVE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-5448
Practice Address - Country:US
Practice Address - Phone:314-576-1495
Practice Address - Fax:314-576-2804
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE006255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
20189OtherBLUE CROSS/BLUE SHIELD
4403250OtherUNITED HEALTH CARE
167594OtherBLUE CROSS/BLUE SHIELD
MO1130904OtherFIRST HEALTH
155354OtherDESERT MUTUAL
32248Medicare ID - Type Unspecified
MO1130904OtherFIRST HEALTH