Provider Demographics
NPI:1457406373
Name:WERNER, KRISTIN A (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:A
Last Name:WERNER
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 1:5316 B N MILWAUKEE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1266
Mailing Address - Country:US
Mailing Address - Phone:773-774-1041
Mailing Address - Fax:773-774-8541
Practice Address - Street 1:5316 B N MILWAUKEE AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1266
Practice Address - Country:US
Practice Address - Phone:773-774-1041
Practice Address - Fax:773-774-8541
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1630133OtherBLUE CROSS BLUE SHIELD
ILK50427Medicare PIN