Provider Demographics
NPI:1518979137
Name:VELOS, CHRISTA MARIE (BS, DC, DICCP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:MARIE
Last Name:VELOS
Suffix:
Gender:F
Credentials:BS, DC, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:IL
Mailing Address - Zip Code:61360-9414
Mailing Address - Country:US
Mailing Address - Phone:815-357-6858
Mailing Address - Fax:815-357-6857
Practice Address - Street 1:260 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:IL
Practice Address - Zip Code:61360-9414
Practice Address - Country:US
Practice Address - Phone:815-357-6858
Practice Address - Fax:815-357-6857
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038008737Medicaid
IL05023003OtherBCBSIL PROVODER #
U76002Medicare UPIN
L71825Medicare ID - Type Unspecified