Provider Demographics
NPI:1760433494
Name:RAYBALL, KRISTIN M (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:M
Last Name:RAYBALL
Suffix:
Gender:F
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6220
Mailing Address - Country:US
Mailing Address - Phone:203-259-3210
Mailing Address - Fax:203-259-3213
Practice Address - Street 1:340 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6220
Practice Address - Country:US
Practice Address - Phone:203-259-3210
Practice Address - Fax:203-259-3213
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1556111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004239803Medicaid
CT350001298Medicare ID - Type Unspecified
CTU98159Medicare UPIN
CTU98159Medicare PIN