Provider Demographics
NPI:1568170181
Name:ITLIONG, CRYSTAL TALINGDAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:TALINGDAN
Last Name:ITLIONG
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 1:3700 THOMAS RD STE 207
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-2063
Mailing Address - Country:US
Mailing Address - Phone:408-248-8700
Mailing Address - Fax:408-247-3180
Practice Address - Street 1:3700 THOMAS RD STE 207
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-2063
Practice Address - Country:US
Practice Address - Phone:408-248-8700
Practice Address - Fax:408-247-3180
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor