Provider Demographics
NPI:1326217282
Name:MALONEY, CRYSTAL ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:ANN
Last Name:MALONEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CRYSTAL
Other - Middle Name:ANN
Other - Last Name:LAURENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1600 SHAWANO AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-3246
Mailing Address - Country:US
Mailing Address - Phone:920-328-8400
Mailing Address - Fax:
Practice Address - Street 1:1600 SHAWANO AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3246
Practice Address - Country:US
Practice Address - Phone:920-328-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4365-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor