Provider Demographics
NPI:1508632126
Name:ARCHULETA, KRISTYN (DC)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:ARCHULETA
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 1:4005 VITRUVIAN WAY APT 180
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4183
Mailing Address - Country:US
Mailing Address - Phone:575-415-5338
Mailing Address - Fax:
Practice Address - Street 1:2021 N MACARTHUR BLVD # 530
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2219
Practice Address - Country:US
Practice Address - Phone:945-356-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor