Provider Demographics
NPI:1306153705
Name:CHRYSTAL, JOSHUA DAVID (NMD, DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DAVID
Last Name:CHRYSTAL
Suffix:
Gender:M
Credentials:NMD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2109
Mailing Address - Country:US
Mailing Address - Phone:818-785-2060
Mailing Address - Fax:
Practice Address - Street 1:4835 VAN NUYS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2109
Practice Address - Country:US
Practice Address - Phone:818-785-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-483175F00000X
CA32023111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111NX0800XChiropractic ProvidersChiropractorOrthopedic