Provider Demographics
NPI:1023063328
Name:ELLIOTT, KRISTINE A (DC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:A
Last Name:ELLIOTT
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 1:1720 HIGHWAY 59 S
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-4331
Mailing Address - Country:US
Mailing Address - Phone:218-681-4747
Mailing Address - Fax:218-683-2595
Practice Address - Street 1:1720 HIGHWAY 59 S
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-4331
Practice Address - Country:US
Practice Address - Phone:218-681-4747
Practice Address - Fax:218-683-2595
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN54G51JOOtherMNBS #
MNDA9020831OtherPREFERRED ONE #
MNHP37471OtherHEALTHPARTNERS #
MN21609OtherNDBS #
MN1577856OtherAMERICA'S PPO/ARAZ #
MN387817100Medicaid
MNU67848OtherUPIN #
MNU67848OtherUPIN #
MNHP37471OtherHEALTHPARTNERS #