Provider Demographics
NPI:1437102217
Name:KAKAVAS, KRISTIAN JOEL VI (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIAN
Middle Name:JOEL
Last Name:KAKAVAS
Suffix:VI
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 1:2318 PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-2231
Mailing Address - Country:US
Mailing Address - Phone:563-242-1512
Mailing Address - Fax:563-241-1087
Practice Address - Street 1:2318 PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2231
Practice Address - Country:US
Practice Address - Phone:563-242-1512
Practice Address - Fax:563-241-1087
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAU95738Medicare UPIN