Provider Demographics
NPI:1235242066
Name:WOODARD, CRYSTAL LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:LYNN
Last Name:WOODARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CRYSTAL
Other - Middle Name:LYNN
Other - Last Name:BALLEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:108 S GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:OBLONG
Mailing Address - State:IL
Mailing Address - Zip Code:62449-1464
Mailing Address - Country:US
Mailing Address - Phone:618-592-6505
Mailing Address - Fax:618-592-6506
Practice Address - Street 1:108 S GARFIELD ST
Practice Address - Street 2:
Practice Address - City:OBLONG
Practice Address - State:IL
Practice Address - Zip Code:62449-1464
Practice Address - Country:US
Practice Address - Phone:618-592-6505
Practice Address - Fax:618-592-6506
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.010551111N00000X
IL038-010551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213502Medicare ID - Type Unspecified