Individual
CRYSTAL MICOLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
10800 OLD COUNTY ROAD 15, PLYMOUTH, MN 55441-6152
(763) 425-4577
Mailing address
10800 OLD COUNTY ROAD 15, PLYMOUTH, MN 55441-6152
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6623
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NON-PAR
—
Enumeration date
08/04/2021
Last updated
08/04/2021
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