Provider Demographics
NPI:1518417922
Name:ALLRED, KRISTINA (MSOM, LAC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:ALLRED
Suffix:
Gender:F
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W APPLEWAY AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-9372
Mailing Address - Country:US
Mailing Address - Phone:208-765-1994
Mailing Address - Fax:
Practice Address - Street 1:213 W APPLEWAY AVE STE 10
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-9372
Practice Address - Country:US
Practice Address - Phone:208-765-1994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000720171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist