Provider Demographics
NPI:1487991519
Name:DR. KRISTA HARLAN, D.C., P.S.C.
Entity type:Organization
Organization Name:DR. KRISTA HARLAN, D.C., P.S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:ENNIS
Authorized Official - Last Name:HARLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-432-2212
Mailing Address - Street 1:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129-0958
Mailing Address - Country:US
Mailing Address - Phone:270-432-2212
Mailing Address - Fax:270-432-2215
Practice Address - Street 1:1704 W STOCKTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:EDMONTON
Practice Address - State:KY
Practice Address - Zip Code:42129-8137
Practice Address - Country:US
Practice Address - Phone:270-432-2212
Practice Address - Fax:270-432-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty