Provider Demographics
NPI:1356713564
Name:CRISTALDI, TERI JANEANE (DC)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:JANEANE
Last Name:CRISTALDI
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 1:628 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-3211
Mailing Address - Country:US
Mailing Address - Phone:406-396-3502
Mailing Address - Fax:
Practice Address - Street 1:628 CEDAR LN
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3211
Practice Address - Country:US
Practice Address - Phone:406-396-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3970111N00000X
FLCH12185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor