Provider Demographics
NPI:1518143833
Name:MATTINGLY, KRISTIN BERATTA (DC)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:BERATTA
Last Name:MATTINGLY
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-0008
Mailing Address - Country:US
Mailing Address - Phone:925-625-1881
Mailing Address - Fax:925-625-4769
Practice Address - Street 1:3478 MAIN ST
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-3137
Practice Address - Country:US
Practice Address - Phone:925-625-1881
Practice Address - Fax:925-625-4769
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-29952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor