Individual
DR. KRYSTIN JADE PROVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C
Contact information
Practice address
112 E 17TH ST, OTTAWA, KS 66067-3800
(785) 242-9393
(913) 538-2289
Mailing address
112 E 17TH ST, OTTAWA, KS 66067-3800
(785) 242-9393
(913) 538-2289
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
01-05533
KS
Other
Enumeration date
05/06/2013
Last updated
07/21/2022
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