Provider Demographics
NPI:1952499899
Name:BENNETT, KRISTY KAY (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:KAY
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:KAY
Other - Last Name:BUHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:908 E. MAIN
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082
Mailing Address - Country:US
Mailing Address - Phone:719-845-0711
Mailing Address - Fax:719-845-0733
Practice Address - Street 1:908 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2725
Practice Address - Country:US
Practice Address - Phone:719-845-0711
Practice Address - Fax:719-845-0733
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC463828Medicare PIN