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NPI Code Detail

MEDICARE: MS. KRISTINA M. KATINKA MSOM L.AC.

MEDICARE: MS. KRISTINA M. KATINKA MSOM L.AC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturistACU176ID

General Provider Information

NPI Number : 1427242650
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRISTINA M. KATINKA MSOM L.AC.
Provider Business Mailing Address
First Line : 1080 W BOISE AVE
Second Line :
City : BOISE
State : ID
Zip : 83706-3502
Country : US
Telephone Number : 208-412-5412
Fax Number :
Provider Business Practice Location Address
First Line : 1080 W BOISE AVE
Second Line :
City : BOISE
State : ID
Zip : 83706-3502
Country : US
Telephone Number : 208-412-5412
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2007
Last Update Date : 08/30/2007

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