Provider Demographics
NPI:1821060955
Name:DYKSTRA, KRISTA LEE (DC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:LEE
Last Name:DYKSTRA
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:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:GEORGE
Mailing Address - State:IA
Mailing Address - Zip Code:51237-0177
Mailing Address - Country:US
Mailing Address - Phone:712-475-3990
Mailing Address - Fax:
Practice Address - Street 1:143 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GEORGE
Practice Address - State:IA
Practice Address - Zip Code:51237-0177
Practice Address - Country:US
Practice Address - Phone:712-475-3990
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA06073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41037OtherWELLMARK BCBS
IA0166421Medicaid
IA22588OtherSIOUX VALLEY HEALTH PLAN
U67747Medicare UPIN
41037Medicare ID - Type Unspecified