Provider Demographics
NPI:1184702037
Name:CARBONELLI, KRISTY (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:
Last Name:CARBONELLI
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:PO BOX 5988
Mailing Address - Street 2:DEPT 20-5003
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5988
Mailing Address - Country:US
Mailing Address - Phone:630-468-1824
Mailing Address - Fax:630-468-1834
Practice Address - Street 1:2217 RTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-9805
Practice Address - Country:US
Practice Address - Phone:815-676-3090
Practice Address - Fax:815-676-3095
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor