Provider Demographics
NPI:1417150541
Name:CRONK, CHRISTINE RENAE (LMP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RENAE
Last Name:CRONK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13701 E SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0715
Mailing Address - Country:US
Mailing Address - Phone:509-928-8869
Mailing Address - Fax:509-928-8874
Practice Address - Street 1:13701 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0715
Practice Address - Country:US
Practice Address - Phone:509-928-8869
Practice Address - Fax:509-928-8874
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022247225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist