Healthcare Provider Details

I. General information

NPI: 1043471410
Provider Name (Legal Business Name): CRYSTAL WHISLER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 05/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 LEPERE AVE #D
SAINT LOUIS MO
63132-4441
US

IV. Provider business mailing address

27001 LA PAZ RD 424A
MISSION VIEJO CA
92691-5502
US

V. Phone/Fax

Practice location:
  • Phone: 949-419-7344
  • Fax:
Mailing address:
  • Phone: 949-340-2571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number29571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: