Provider Demographics
NPI:1982957874
Name:CRYSTAL CLEAR CHIROPRACTIC CENTER LTD
Entity Type:Organization
Organization Name:CRYSTAL CLEAR CHIROPRACTIC CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:HUXLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-345-1791
Mailing Address - Street 1:832 W. BASELINE RD
Mailing Address - Street 2:SUITE #25
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-9523
Mailing Address - Country:US
Mailing Address - Phone:480-345-1791
Mailing Address - Fax:480-345-7812
Practice Address - Street 1:832 W. BASELINE RD
Practice Address - Street 2:SUITE # 25
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-9523
Practice Address - Country:US
Practice Address - Phone:480-345-1791
Practice Address - Fax:480-345-7812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty