Provider Demographics
NPI:1396754313
Name:MARTIN, CRYSTAL (DC)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40402 62ND AVE E
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-9599
Mailing Address - Country:US
Mailing Address - Phone:405-921-6564
Mailing Address - Fax:
Practice Address - Street 1:9144 BURNETT RD SE
Practice Address - Street 2:SUITE B1 AND B2
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8488
Practice Address - Country:US
Practice Address - Phone:360-400-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60394038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK24M713810Medicare UPIN