Kristen Marie Johansen, D.C.
Individual provider Active NPI Chiropractor · Worth, IL
NPI 1992826119 · NPPES record last updated Oct 15, 2009
Key facts
- NPI
- 1992826119
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 038-008775 (IL)
- Practice address
- 6852 W 111TH St
Worth, IL 60482-1823 - Phone
- (708) 448-3818
- Fax
- (708) 448-3804
- NPI assigned
- Apr 3, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038-008775 | IL | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038-008775 | IL | Yes |
Addresses
Primary practice location
6852 W 111TH St
Worth, IL 60482-1823
Mailing address
6852 W 111TH St
Worth, IL 60482-1823
Phone (708) 448-3818
Other names
- Kristen Marie Gustafson
Other providers in Worth, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.