MEDICARE: CRYSTAL MARLENE MCLAUGHLIN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B01017	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	667297	OTHER	NV	BC BS NUMBER
2	B01017	OTHER	NV	NV LICENSE NUMBER

General Provider Information

NPI Number	:	1780751164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MARLENE MCLAUGHLIN D.C.

Provider Business Mailing Address
First Line	:	7600 GLADSTONE DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89506-1960
Country	:	US
Telephone Number	:	775-747-4333
Fax Number	:	775-324-2370

Provider Business Practice Location Address
First Line	:	5365 MAE ANNE AVE
Second Line	:	STE. B-2
City	:	RENO
State	:	NV
Zip	:	89523-1840
Country	:	US
Telephone Number	:	775-747-4333
Fax Number	:	775-324-2370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	06/01/2012

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