Provider Demographics
NPI:1851905871
Name:VENTURINO, CRYSTAL MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:MARIE
Last Name:VENTURINO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:MARIE
Other - Last Name:BURGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:14491 UNIVERSITY COVE PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3741
Mailing Address - Country:US
Mailing Address - Phone:813-977-2383
Mailing Address - Fax:813-977-2585
Practice Address - Street 1:14491 UNIVERSITY COVE PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3741
Practice Address - Country:US
Practice Address - Phone:813-977-2383
Practice Address - Fax:813-977-2585
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13129111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty