Provider Demographics
NPI:1821128752
Name:FAIRMAN, CRYSTAL LYNN (DC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LYNN
Last Name:FAIRMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LYNN
Other - Last Name:HERSHBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:537 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15530-1344
Mailing Address - Country:US
Mailing Address - Phone:814-267-6440
Mailing Address - Fax:814-267-6442
Practice Address - Street 1:537 MAIN ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:PA
Practice Address - Zip Code:15530-1344
Practice Address - Country:US
Practice Address - Phone:814-267-6440
Practice Address - Fax:814-267-6442
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA089371Medicare ID - Type Unspecified