Provider Demographics
NPI:1023049756
Name:HEALY, KRISTA VICKI (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:VICKI
Last Name:HEALY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KRISTA
Other - Middle Name:VICKI
Other - Last Name:HAWES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:9019 SOQUEL DR STE 1C
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003
Mailing Address - Country:US
Mailing Address - Phone:831-419-9289
Mailing Address - Fax:
Practice Address - Street 1:9019 SOQUEL DR STE 1C
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003
Practice Address - Country:US
Practice Address - Phone:831-419-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0276060Medicare ID - Type Unspecified