Provider Demographics
NPI:1831424183
Name:BRAVO, KRISTEN (DC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BRAVO
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 1:8520 ALLISON POINTE BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-5700
Mailing Address - Country:US
Mailing Address - Phone:317-606-9466
Mailing Address - Fax:
Practice Address - Street 1:8520 ALLISON POINTE BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-5700
Practice Address - Country:US
Practice Address - Phone:317-606-9466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002511A111N00000X
IN81000109A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor