Provider Demographics
NPI:1679627491
Name:CRILLY, ROBIN LIN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:LIN
Last Name:CRILLY
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 1:1129 W PORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-2128
Mailing Address - Country:US
Mailing Address - Phone:831-801-7092
Mailing Address - Fax:
Practice Address - Street 1:1129 W PORTLAND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-2128
Practice Address - Country:US
Practice Address - Phone:831-801-7092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0201500Medicare ID - Type UnspecifiedCHIROPRACTOR
CAV071480Medicare UPIN