Provider Demographics
NPI:1639186737
Name:CLINTON, KRISTINA LEIGH (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:LEIGH
Last Name:CLINTON
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 1:3109 KENAI DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2540
Mailing Address - Country:US
Mailing Address - Phone:512-363-5178
Mailing Address - Fax:512-339-2664
Practice Address - Street 1:3109 KENAI DR STE 101
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2540
Practice Address - Country:US
Practice Address - Phone:512-363-5178
Practice Address - Fax:512-339-2664
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX607005OtherBCBS PROVIDER #