Provider Demographics
NPI:1679519151
Name:PROSPER, CHRISTIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:
Last Name:PROSPER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:MCKITTRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4203 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2729
Mailing Address - Country:US
Mailing Address - Phone:248-616-0900
Mailing Address - Fax:248-616-1911
Practice Address - Street 1:4203 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-2729
Practice Address - Country:US
Practice Address - Phone:248-616-0900
Practice Address - Fax:248-616-1911
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-OF326950OtherBCBS
MI95-OF326950OtherBCBS