Provider Demographics
NPI:1720087331
Name:UDE, KRISTEN KATHERINE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:KATHERINE
Last Name:UDE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13021 LEGENDARY DR
Mailing Address - Street 2:APT. 1318
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3934
Mailing Address - Country:US
Mailing Address - Phone:512-970-8883
Mailing Address - Fax:512-451-8686
Practice Address - Street 1:1600 W 38TH ST
Practice Address - Street 2:SUITE 412
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6400
Practice Address - Country:US
Practice Address - Phone:512-970-8883
Practice Address - Fax:512-451-8686
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10555111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AA820OtherBCBS
TX8AA820OtherBCBS