Provider Demographics
NPI:1558597930
Name:GULLO-BUZZETTI, CRYSTAL (DC)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:GULLO-BUZZETTI
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 1:147 W GRAY ST
Mailing Address - Street 2:207
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3017
Mailing Address - Country:US
Mailing Address - Phone:607-731-8155
Mailing Address - Fax:607-793-9562
Practice Address - Street 1:147 W GRAY ST
Practice Address - Street 2:207
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3017
Practice Address - Country:US
Practice Address - Phone:607-731-8155
Practice Address - Fax:607-793-9562
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-30
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor