Provider Demographics
NPI:1720681604
Name:BOWLAND, CRYSTAL (LAC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BOWLAND
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 1:1351 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-4984
Mailing Address - Country:US
Mailing Address - Phone:970-775-7499
Mailing Address - Fax:
Practice Address - Street 1:1351 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-4984
Practice Address - Country:US
Practice Address - Phone:970-599-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty