Provider Demographics
NPI:1083379457
Name:CLIFF, CRYSTAL NOELLE (DACM)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:NOELLE
Last Name:CLIFF
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 CHESTERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-0013
Mailing Address - Country:US
Mailing Address - Phone:980-819-1213
Mailing Address - Fax:
Practice Address - Street 1:2010 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-0013
Practice Address - Country:US
Practice Address - Phone:980-819-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC737171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0737OtherACUPUNCTURE LICENSE