Provider Demographics
NPI:1457500290
Name:WILKS, KRISTA ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:ELIZABETH
Last Name:WILKS
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 1:4305 CROW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-2456
Mailing Address - Country:US
Mailing Address - Phone:314-852-9438
Mailing Address - Fax:
Practice Address - Street 1:4736 EAGLERIDGE CIR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2120
Practice Address - Country:US
Practice Address - Phone:719-404-1489
Practice Address - Fax:719-545-0642
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008028550111N00000X
CO6469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor