Provider Demographics
NPI:1558348995
Name:KRAWCHUK, CELESTE MARIE (DC)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:MARIE
Last Name:KRAWCHUK
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 1:101 E MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22611-1384
Mailing Address - Country:US
Mailing Address - Phone:540-955-3355
Mailing Address - Fax:540-955-0498
Practice Address - Street 1:101 E MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-1384
Practice Address - Country:US
Practice Address - Phone:540-955-3355
Practice Address - Fax:540-955-0498
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA465994OtherANTHEM
VA70466OtherOPTIMA
WV2202095000Medicaid
612441OtherHEALTH LINK NCPPO
601858500OtherUS DEPT OF LABOR
VA70466OtherOPTIMA
VA465994OtherANTHEM