Provider Demographics
NPI:1730138520
Name:VANDERLIP-CHOMYSZAK, KRISTI LEE (DC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LEE
Last Name:VANDERLIP-CHOMYSZAK
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 1:62 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4701
Mailing Address - Country:US
Mailing Address - Phone:607-772-0845
Mailing Address - Fax:
Practice Address - Street 1:62 FRONT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4701
Practice Address - Country:US
Practice Address - Phone:607-772-0845
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011173-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor