Provider Demographics
NPI:1447296512
Name:VAN DE CARR, KRISTEN (DC)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:VAN DE CARR
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 1:8640 HAINES DR STE A
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-6935
Mailing Address - Country:US
Mailing Address - Phone:859-620-1325
Mailing Address - Fax:144-012-4846
Practice Address - Street 1:8640 HAINES DR STE A
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-6935
Practice Address - Country:US
Practice Address - Phone:859-240-3596
Practice Address - Fax:614-401-2484
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251611111N00000X, 111N00000X
OH4286111N00000X
CO5578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5632232OtherBLUE CROSS ID #
ILK25396OtherMEDICARE ID #
ILV08376OtherNEW MEDICARE UPIN
V07843Medicare UPIN
IL213040Medicare PIN