Provider Demographics
NPI:1992868574
Name:WASHBURN, CRYSTAL DAWN (DC)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:DAWN
Last Name:WASHBURN
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:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-0909
Mailing Address - Country:US
Mailing Address - Phone:575-445-8811
Mailing Address - Fax:575-445-8686
Practice Address - Street 1:230 GALISTEO AVE
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-4026
Practice Address - Country:US
Practice Address - Phone:505-445-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor