Provider Demographics
NPI:1679671804
Name:METTLER, KRISTI JANE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:JANE
Last Name:METTLER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KRISTI
Other - Middle Name:JANE
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:105 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55975-1227
Mailing Address - Country:US
Mailing Address - Phone:507-346-1077
Mailing Address - Fax:507-346-7117
Practice Address - Street 1:105 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55975-1227
Practice Address - Country:US
Practice Address - Phone:507-346-1077
Practice Address - Fax:507-346-7117
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN587728800Medicaid
MN5C276CHOtherBCBS
MNU42065Medicare UPIN
MN587728800Medicaid