Provider Demographics
NPI:1063509867
Name:JOSEPH, CRYSTAL A (DC, AK, CCSP)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:A
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:DC, AK, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SOUTH BROADWAY
Mailing Address - Street 2:UNIT C-10
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5623
Mailing Address - Country:US
Mailing Address - Phone:917-828-6733
Mailing Address - Fax:914-332-4370
Practice Address - Street 1:928 BROADWAY STE 905
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8119
Practice Address - Country:US
Practice Address - Phone:917-828-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3164111NS0005X
NYX008088111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician