MEDICARE: VIKTORIA KRISLATY DC

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
1	111N00000X	Chiropractor	DC-04829	OH

General Provider Information

NPI Number	:	1518420660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIKTORIA KRISLATY DC

Provider Business Mailing Address
First Line	:	13708 MADISON AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4711
Country	:	US
Telephone Number	:	216-221-2008
Fax Number	:

Provider Business Practice Location Address
First Line	:	13708 MADISON AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4711
Country	:	US
Telephone Number	:	216-221-2008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2019
Last Update Date	:	04/07/2019

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Directions to “ VIKTORIA KRISLATY DC” Practice Location

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