Provider Demographics
NPI:1396128807
Name:BEMIS, KRISTINA ELAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:ELAYNE
Last Name:BEMIS
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:PO BOX 796
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-0796
Mailing Address - Country:US
Mailing Address - Phone:618-463-1600
Mailing Address - Fax:618-463-1624
Practice Address - Street 1:4105 HUMBERT RD
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-7161
Practice Address - Country:US
Practice Address - Phone:618-463-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214848Medicare PIN