Provider Demographics
NPI:1063761732
Name:CHUKWUEMEKA, KRYSTAL NNEKA (LMT)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:NNEKA
Last Name:CHUKWUEMEKA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2348
Mailing Address - Country:US
Mailing Address - Phone:304-416-0096
Mailing Address - Fax:
Practice Address - Street 1:1017 6TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2348
Practice Address - Country:US
Practice Address - Phone:304-416-0096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2009-2576225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist