Provider Demographics
NPI:1013928365
Name:KANCIUS, CHRISTINE CELESTE (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:CELESTE
Last Name:KANCIUS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3827 N PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61616
Mailing Address - Country:US
Mailing Address - Phone:309-686-1000
Mailing Address - Fax:309-686-8174
Practice Address - Street 1:1945 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550
Practice Address - Country:US
Practice Address - Phone:309-263-1017
Practice Address - Fax:309-266-5864
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDA0891OtherPALMETTO GBA- RAILROAD ME
L97270Medicare UPIN
IL205059Medicare ID - Type Unspecified
IL4768490001Medicare NSC