Provider Demographics
NPI:1477631091
Name:MULVEY, KRIS (DC)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:
Last Name:MULVEY
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:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:OSSIAN
Mailing Address - State:IN
Mailing Address - Zip Code:46777-0393
Mailing Address - Country:US
Mailing Address - Phone:260-622-6418
Mailing Address - Fax:260-622-9010
Practice Address - Street 1:111 S. JEFFERSON ST.
Practice Address - Street 2:
Practice Address - City:OSSIAN
Practice Address - State:IN
Practice Address - Zip Code:46777
Practice Address - Country:US
Practice Address - Phone:260-622-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002212A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN230150Medicare ID - Type Unspecified