Provider Demographics
NPI:1841425733
Name:DANIEL, KRISTI GRADY (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:GRADY
Last Name:DANIEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:577 CHESTNUT RIDGE RD
Mailing Address - Street 2:(2ND FLOOR)
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-8409
Mailing Address - Country:US
Mailing Address - Phone:201-424-6694
Mailing Address - Fax:
Practice Address - Street 1:577 CHESTNUT RIDGE RD
Practice Address - Street 2:(2ND FLOOR)
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8409
Practice Address - Country:US
Practice Address - Phone:201-424-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00680500111N00000X
NY011813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE