Provider Demographics
NPI:1427366780
Name:WAFER, CRISTIN VITEK (DC)
Entity type:Individual
Prefix:
First Name:CRISTIN
Middle Name:VITEK
Last Name:WAFER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CRISTIN
Other - Middle Name:DIANNE
Other - Last Name:VITEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:505 S MASON RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2491
Mailing Address - Country:US
Mailing Address - Phone:281-579-1116
Mailing Address - Fax:281-579-0395
Practice Address - Street 1:505 S MASON RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2491
Practice Address - Country:US
Practice Address - Phone:281-579-1116
Practice Address - Fax:281-579-0395
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB114991OtherMEDICARE INDIVIDUAL PTAN
TX601426OtherMEDICARE GROUP PTAN