Basic Information
Provider Information
NPI: 1003148842
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PFISTERER
FirstName: CRYSTAL
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: D.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8942 XERXES CIR S
Address2:  
City: BLOOMINGTON
State: MN
PostalCode: 554311961
CountryCode: US
TelephoneNumber: 9524842176
FaxNumber: 9522231134
Practice Location
Address1: 5509 EDEN PRAIRIE RD
Address2:  
City: MINNETONKA
State: MN
PostalCode: 553455839
CountryCode: US
TelephoneNumber: 9524467177
FaxNumber: 9528435650
Other Information
ProviderEnumerationDate: 02/04/2010
LastUpdateDate: 10/27/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000X5264MNY Chiropractic ProvidersChiropractor 
111N00000X5466KYN Chiropractic ProvidersChiropractor 
111NI0013X877MNN Chiropractic ProvidersChiropractorIndependent Medical Examiner

No ID Information.


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