Provider Demographics
NPI:1265404347
Name:KMIEC, CHRISTINE M (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:M
Last Name:KMIEC
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:KMIEC-DEPIETRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:371 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2005
Mailing Address - Country:US
Mailing Address - Phone:570-558-2225
Mailing Address - Fax:570-558-6325
Practice Address - Street 1:371 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2005
Practice Address - Country:US
Practice Address - Phone:570-558-2225
Practice Address - Fax:570-558-6325
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA008926111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001439457OtherBLUECROSS BLUE SHIELD
PA001439457OtherBLUECROSS BLUE SHIELD
PA087750Medicare ID - Type Unspecified