Provider Demographics
NPI:1215087598
Name:ACCARDO, KRISTEN A (DC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:ACCARDO
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 1:1231 FARMINGTON LAKES DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9040
Mailing Address - Country:US
Mailing Address - Phone:331-212-6962
Mailing Address - Fax:630-429-9276
Practice Address - Street 1:1231 FARMINGTON LAKES DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9040
Practice Address - Country:US
Practice Address - Phone:331-212-6962
Practice Address - Fax:630-429-9276
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012304111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL8529Medicare PIN
VA350000958Medicare ID - Type Unspecified
VA350000958Medicare PIN
VA264-574OtherANTHEM
VAU73582Medicare UPIN
ILIL8529Medicare PIN