Provider Demographics
NPI:1750481321
Name:PELTON, CHRISTINE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:LYNN
Last Name:PELTON
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 1:730 KINGSTOWN RD STE 3
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3002
Mailing Address - Country:US
Mailing Address - Phone:401-782-8380
Mailing Address - Fax:401-782-3650
Practice Address - Street 1:730 KINGSTOWN RD STE 3
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3002
Practice Address - Country:US
Practice Address - Phone:401-782-8380
Practice Address - Fax:401-782-3650
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDC323111N00000X
MA1685111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI91455OtherBLUE CROSS/SHIELD
RI4400020OtherCOMMERCIAL
RIU33948Medicare UPIN