Provider Demographics
NPI:1629282124
Name:TACK, CRYSTAL (ND LAC)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:TACK
Suffix:
Gender:F
Credentials:ND LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-6809
Mailing Address - Country:US
Mailing Address - Phone:360-683-2937
Mailing Address - Fax:
Practice Address - Street 1:344 HOUSE RD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-6809
Practice Address - Country:US
Practice Address - Phone:360-683-2937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000627175F00000X
WAAC00000023171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist