Provider Demographics
NPI:1437855442
Name:CHRIST, KASEY (DC)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:CHRIST
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 1:222 W HUNTERS RDG
Mailing Address - Street 2:
Mailing Address - City:VALMEYER
Mailing Address - State:IL
Mailing Address - Zip Code:62295-3019
Mailing Address - Country:US
Mailing Address - Phone:618-406-1342
Mailing Address - Fax:
Practice Address - Street 1:208 E MILL ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1519
Practice Address - Country:US
Practice Address - Phone:618-939-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor