Basic Information
| Provider Information | |||||||||
| NPI: | 1659580702 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | KRYSTAL | ||||||||
| MiddleName: | SHERRI | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 986 | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952580986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093399036 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2000 W KETTLEMAN LN STE 104 | ||||||||
| Address2: | |||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952424334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093346947 | ||||||||
| FaxNumber: | 2093346969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 10/26/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC 30023 | CA | Y | Chiropractic Providers | Chiropractor |
No ID Information.