Provider Demographics
NPI:1811909633
Name:SARGENT, KRISTINA L (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:L
Last Name:SARGENT
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 1:416 E ROOSEVELT RD
Mailing Address - Street 2:STE 107
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5589
Mailing Address - Country:US
Mailing Address - Phone:630-682-5090
Mailing Address - Fax:630-260-1230
Practice Address - Street 1:416 E ROOSEVELT RD
Practice Address - Street 2:STE 107
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5589
Practice Address - Country:US
Practice Address - Phone:630-682-5090
Practice Address - Fax:630-260-1230
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007040111NI0900X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215708OtherBCBS
IL601205300OtherFED WORK COMP
IL271151301OtherLBN
IL601205300OtherFED WORK COMP
IL02215708OtherBCBS
IL363820035OtherTIN