Provider Demographics
NPI:1457602005
Name:KRISTIN JANELLE LICHTY
Entity Type:Organization
Organization Name:KRISTIN JANELLE LICHTY
Other - Org Name:INFINITY CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LICHTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-406-0283
Mailing Address - Street 1:51 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4068
Mailing Address - Country:US
Mailing Address - Phone:608-406-0283
Mailing Address - Fax:
Practice Address - Street 1:51 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4068
Practice Address - Country:US
Practice Address - Phone:608-406-0283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-23
Last Update Date:2012-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty