Physician Compare National (NPI:1508395302)

HEALTHCARE PROVIDER: CRYSTAL M FOLTA DC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1508395302
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5092062745
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180726000476
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FOLTA
	Individual professional last name
Provider First Name	CRYSTAL
	Individual professional first name
Provider Middle Name	MARIE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LIFE CHIROPRACTIC COLLEGE
	Individual professional's medical school
Graduation Year	2017
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	20307 VIKING AVE NW
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 102
	Group Practice or individual's line 2 address
City	POULSBO
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	983708321
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M