Provider Demographics
NPI:1871045518
Name:GAULEY, KRYSTAL R (LMT)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:R
Last Name:GAULEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-0061
Mailing Address - Country:US
Mailing Address - Phone:970-390-4431
Mailing Address - Fax:
Practice Address - Street 1:225 MAIN ST
Practice Address - Street 2:KLONDIKE CHIROPRACTIC
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827
Practice Address - Country:US
Practice Address - Phone:907-766-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK113227225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist