Healthcare Provider Details

I. General information

NPI: 1518969401
Provider Name (Legal Business Name): KRISTY FLEAGANE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 INWOOD RD
WEST JEFFERSON OH
43162-1112
US

IV. Provider business mailing address

25 INWOOD RD
WEST JEFFERSON OH
43162-1112
US

V. Phone/Fax

Practice location:
  • Phone: 614-879-5070
  • Fax: 614-879-5023
Mailing address:
  • Phone: 614-879-5070
  • Fax: 614-879-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1736
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: