Provider Demographics
NPI:1275987356
Name:MACKIE, CHRISTINA JOY (ND)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JOY
Last Name:MACKIE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 CHADOWES ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1728
Mailing Address - Country:US
Mailing Address - Phone:316-259-6409
Mailing Address - Fax:
Practice Address - Street 1:728 W DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-6104
Practice Address - Country:US
Practice Address - Phone:316-259-6409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21-00036175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath