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Individual

MISS CRYSTAL BLANTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RD,LDN

Contact information

Practice address
190 E DELAWARE PL, CHICAGO, IL 60611-1813
(773) 947-7331
Mailing address
15424 DREXEL AVE, DOLTON, IL 60419-2748
(773) 519-9477

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164004659
IL

Other

Enumeration date
10/24/2011
Last updated
10/24/2011
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