Provider Demographics
NPI:1548982473
Name:KRIVINCHUK, KALI R (DC)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:R
Last Name:KRIVINCHUK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-6110
Mailing Address - Country:US
Mailing Address - Phone:218-343-7173
Mailing Address - Fax:
Practice Address - Street 1:8170 S HIGHLAND DR STE E4
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6465
Practice Address - Country:US
Practice Address - Phone:801-942-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12810668-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor