Provider Demographics
NPI:1477208577
Name:DE CRISTOFARO, CRISTINA NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:NICOLE
Last Name:DE CRISTOFARO
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 1:1326 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1703
Mailing Address - Country:US
Mailing Address - Phone:208-884-3368
Mailing Address - Fax:208-884-3394
Practice Address - Street 1:1326 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1703
Practice Address - Country:US
Practice Address - Phone:208-884-3368
Practice Address - Fax:208-884-3394
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36228111N00000X
IDCHIA-2295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor