Provider Demographics
NPI:1194250787
Name:CROUCHER, EDWIN ERNEST III (DC)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:ERNEST
Last Name:CROUCHER
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2720
Mailing Address - Country:US
Mailing Address - Phone:315-635-2333
Mailing Address - Fax:
Practice Address - Street 1:136 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2720
Practice Address - Country:US
Practice Address - Phone:315-635-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor