Provider Demographics
NPI:1679248959
Name:CHURCH, KRISTI (DC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:CHURCH
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 1:2745 HIGH RIDGE BLVD STE 5B
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-2200
Mailing Address - Country:US
Mailing Address - Phone:636-495-1525
Mailing Address - Fax:
Practice Address - Street 1:2745 HIGH RIDGE BLVD STE 5B
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-2200
Practice Address - Country:US
Practice Address - Phone:636-495-1525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13652111N00000X
MO2022005939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor