Provider Demographics
NPI:1780751164
Name:MCLAUGHLIN, CRYSTAL MARLENE (DC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARLENE
Last Name:MCLAUGHLIN
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 1:7600 GLADSTONE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-1960
Mailing Address - Country:US
Mailing Address - Phone:775-747-4333
Mailing Address - Fax:775-324-2370
Practice Address - Street 1:5365 MAE ANNE AVE
Practice Address - Street 2:STE. B-2
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-1840
Practice Address - Country:US
Practice Address - Phone:775-747-4333
Practice Address - Fax:775-324-2370
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV667297OtherBC BS NUMBER
NVB01017OtherNV LICENSE NUMBER
NVV38714Medicare PIN
NVU98720Medicare UPIN
NV667297OtherBC BS NUMBER