Provider Demographics
NPI:1144540360
Name:LOGGINS, CRYSTAL LEE (DC)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:LEE
Last Name:LOGGINS
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 1:30120 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2190
Mailing Address - Country:US
Mailing Address - Phone:586-949-9248
Mailing Address - Fax:
Practice Address - Street 1:30120 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-2190
Practice Address - Country:US
Practice Address - Phone:586-949-9248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor