Provider Demographics
NPI:1710424551
Name:SCARFFE, KRISTIE GAIL
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:GAIL
Last Name:SCARFFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345-1582
Mailing Address - Country:US
Mailing Address - Phone:616-322-7532
Mailing Address - Fax:
Practice Address - Street 1:450 S STATE ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-1582
Practice Address - Country:US
Practice Address - Phone:616-383-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor