Provider Demographics
NPI:1801034681
Name:WODICKA, KRISTINA ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:ELIZABETH
Last Name:WODICKA
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 1:311 N MIDLAND AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1627
Mailing Address - Country:US
Mailing Address - Phone:845-353-7360
Mailing Address - Fax:845-353-7362
Practice Address - Street 1:311 N MIDLAND AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1627
Practice Address - Country:US
Practice Address - Phone:845-353-7360
Practice Address - Fax:845-353-7362
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008898-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor