Provider Demographics
NPI:1487801569
Name:CRYSTAL CHIROPRACTIC PC
Entity type:Organization
Organization Name:CRYSTAL CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRYSTAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-822-1922
Mailing Address - Street 1:109 MAPLE ROW BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-1605
Mailing Address - Country:US
Mailing Address - Phone:615-822-1922
Mailing Address - Fax:615-822-1926
Practice Address - Street 1:109 MAPLE ROW BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1605
Practice Address - Country:US
Practice Address - Phone:615-822-1922
Practice Address - Fax:615-822-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC00000762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty