Provider Demographics
NPI:1841546934
Name:KRISTY L CLINTON DC PA
Entity type:Organization
Organization Name:KRISTY L CLINTON DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-363-5178
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1639286737OtherNPI