Provider Demographics
NPI:1538256326
Name:CROMARTIE, IRIS GAIL (LAC)
Entity type:Individual
Prefix:MS
First Name:IRIS
Middle Name:GAIL
Last Name:CROMARTIE
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 1:1516 WILLOWROSS DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3704
Mailing Address - Country:US
Mailing Address - Phone:972-436-1052
Mailing Address - Fax:
Practice Address - Street 1:5924 W PARKER RD STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6417
Practice Address - Country:US
Practice Address - Phone:972-473-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00636171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist