Basic Information
| Provider Information | |||||||||
| NPI: | 1023063328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELLIOTT | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 HIGHWAY 59 S | ||||||||
| Address2: | |||||||||
| City: | THIEF RIVER FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 567014331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186814747 | ||||||||
| FaxNumber: | 2186832595 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 HIGHWAY 59 S | ||||||||
| Address2: | |||||||||
| City: | THIEF RIVER FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 567014331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186814747 | ||||||||
| FaxNumber: | 2186832595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 01/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 628 | MN | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 54G51JO | 01 | MN | MNBS # | OTHER | DA9020831 | 01 | MN | PREFERRED ONE # | OTHER | HP37471 | 01 | MN | HEALTHPARTNERS # | OTHER | 21609 | 01 | MN | NDBS # | OTHER | 1577856 | 01 | MN | AMERICA'S PPO/ARAZ # | OTHER | 387817100 | 05 | MN | MEDICAID | U67848 | 01 | MN | UPIN # | OTHER |