Provider Demographics
NPI:1891332912
Name:CIODYK, CHRYSTAL (LAC, DIPL OM, DACM)
Entity type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:
Last Name:CIODYK
Suffix:
Gender:F
Credentials:LAC, DIPL OM, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 W STATE ST APT 101
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-1458
Mailing Address - Country:US
Mailing Address - Phone:815-200-1061
Mailing Address - Fax:
Practice Address - Street 1:437 W STATE ST APT 101
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1458
Practice Address - Country:US
Practice Address - Phone:815-200-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001474171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL83-4105198OtherIRS