Provider Demographics
NPI:1669404372
Name:KRIVAN, KATHERINE (DC)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:KRIVAN
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 1:10855 PINE CONE DR
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-3154
Mailing Address - Country:US
Mailing Address - Phone:520-990-9788
Mailing Address - Fax:
Practice Address - Street 1:10855 PINE CONE DR
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-3154
Practice Address - Country:US
Practice Address - Phone:520-990-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2890111N00000X
TX10324111N00000X
AZ7851111N00000X
CA32799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY37031OtherBCBS
MAY45700Medicare ID - Type Unspecified