Healthcare Provider Details

I. General information

NPI: 1033421532
Provider Name (Legal Business Name): KRYSTEN TATAREK D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 N DAMEN AVE STE 1
CHICAGO IL
60618-3277
US

IV. Provider business mailing address

2511 W MOFFAT ST APT 102
CHICAGO IL
60647-4388
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-2766
  • Fax: 773-296-2768
Mailing address:
  • Phone: 773-782-7410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038011455
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number038011455
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number038011455
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number038011455
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038011455
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number038011455
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number038011455
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038011455
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: