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General NPI Number Information
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NPI Number | 1487991519
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Entity Type | Organization
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Legal Business Name | DR. KRISTA HARLAN, D.C., P.S.C.
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Dates
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Enumeration Date | 01/09/2013
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 1704 W STOCKTON ST SUITE C
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City | EDMONTON
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State | KY
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Zip | 42129-8137
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Country | US
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Telephone | 270-432-2212
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Fax | 270-432-2215
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Provider Business Mailing Address
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Address Line | PO BOX 958
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City | EDMONTON
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State | KY
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Zip | 42129-0958
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Country | US
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Telephone | 270-432-2212
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Fax | 270-432-2215
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISTA ENNIS HARLAN
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Credential | D.C.
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Telephone | 270-432-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5370
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License Number State | KY
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