Provider Demographics
NPI:1376141911
Name:CRYSTAL VENTURINO DC LLC
Entity Type:Organization
Organization Name:CRYSTAL VENTURINO DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VENTURINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-977-2383
Mailing Address - Street 1:14491 UNIVERSITY COVE PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3741
Mailing Address - Country:US
Mailing Address - Phone:813-977-2383
Mailing Address - Fax:813-977-2585
Practice Address - Street 1:14491 UNIVERSITY COVE PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3741
Practice Address - Country:US
Practice Address - Phone:813-977-2383
Practice Address - Fax:813-977-2585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRYSTAL VENTURINO DC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-15
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty