Provider Demographics
NPI:1003998139
Name:EMERSON, CRISTY ANN (DC)
Entity Type:Individual
Prefix:
First Name:CRISTY
Middle Name:ANN
Last Name:EMERSON
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 1:27881 LA PAZ RD # G217
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3933
Mailing Address - Country:US
Mailing Address - Phone:949-297-3711
Mailing Address - Fax:949-831-1762
Practice Address - Street 1:27401 LOS ALTOS STE 485
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8534
Practice Address - Country:US
Practice Address - Phone:949-297-3711
Practice Address - Fax:949-831-1762
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU82720Medicare UPIN