Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC-4929L | PA |
NPI | 1003905399 |
---|---|
Provider Name | Dr. Kristine M. Nelson |
First Address | Waterford, PA 16441-0757 |
Second Address | Waterford, PA 16441-8301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
725732 | HIGHMARK BLUE SHIELD (01) | PA |
V01988 | (02) | PA |