Provider Demographics
NPI:1083671382
Name:JAMES-COBOURN, CRYSTAL M (DC)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:M
Last Name:JAMES-COBOURN
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 1:200 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1150
Mailing Address - Country:US
Mailing Address - Phone:570-253-9039
Mailing Address - Fax:570-253-9052
Practice Address - Street 1:200 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1150
Practice Address - Country:US
Practice Address - Phone:570-253-9039
Practice Address - Fax:570-253-9052
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008948111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA19386000001Medicaid
PA066199Medicare ID - Type UnspecifiedMEDICARE #
PAU93500Medicare UPIN