Provider Demographics
NPI:1124261961
Name:URBAN, CRYSTAL LYNN (ND, MSOM, LAC)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:LYNN
Last Name:URBAN
Suffix:
Gender:F
Credentials:ND, MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W1515 MIDDLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:WI
Mailing Address - Zip Code:54162
Mailing Address - Country:US
Mailing Address - Phone:715-477-2431
Mailing Address - Fax:
Practice Address - Street 1:W1515 MIDDLE DRIVE
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:WI
Practice Address - Zip Code:54162
Practice Address - Country:US
Practice Address - Phone:715-477-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1179175F00000X
WI305-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath