1972930121 NPI number — MS. KRISTY ALEXANDRA CADA DC

Table of content: MS. KRISTY ALEXANDRA CADA DC (NPI 1972930121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972930121 NPI number — MS. KRISTY ALEXANDRA CADA DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CADA
Provider First Name:
KRISTY
Provider Middle Name:
ALEXANDRA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972930121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2625 BUTTERFIELD RD STE 301N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-1266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-438-1824
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2210 CAMDEN CT STE 1E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK BROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-468-1820
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038012488 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)