Provider Demographics
NPI:1932300407
Name:ELLIOTT, KRISTEN SHEA (DC, CAC, FICPA)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:SHEA
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DC, CAC, FICPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 LAKE GRAYSON DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4987
Mailing Address - Country:US
Mailing Address - Phone:281-394-5627
Mailing Address - Fax:281-394-5629
Practice Address - Street 1:1702 LAKE GRAYSON DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4987
Practice Address - Country:US
Practice Address - Phone:281-394-5627
Practice Address - Fax:281-394-5629
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX492247Medicare UPIN
TX609770Medicare ID - Type Unspecified