Provider Demographics
NPI:1982232070
Name:CRUTCHFIELD, ASHLEY (LAC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CRUTCHFIELD
Suffix:
Gender:F
Credentials:LAC
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 21304
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4304
Mailing Address - Country:US
Mailing Address - Phone:303-861-5656
Mailing Address - Fax:
Practice Address - Street 1:5455 W 38TH AVE UNIT C
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80212-7068
Practice Address - Country:US
Practice Address - Phone:303-861-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO451171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist