Provider Demographics
NPI:1538768676
Name:RODENBECK, CRYSTAL LASHAY (DC)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:LASHAY
Last Name:RODENBECK
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 1:1215 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-3074
Mailing Address - Country:US
Mailing Address - Phone:615-461-5743
Mailing Address - Fax:
Practice Address - Street 1:1215 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-3074
Practice Address - Country:US
Practice Address - Phone:615-461-5743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN00000002843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor