Provider Demographics
NPI:1699963892
Name:SCURLOCK, KRISTEN K (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:K
Last Name:SCURLOCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6630 S MCCARRAN BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6145
Mailing Address - Country:US
Mailing Address - Phone:775-829-0177
Mailing Address - Fax:775-829-7741
Practice Address - Street 1:6630 S MCCARRAN BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6145
Practice Address - Country:US
Practice Address - Phone:775-829-0177
Practice Address - Fax:775-829-7741
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB1058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV00990Medicare UPIN