Provider Demographics
NPI:1215507496
Name:BASILIERE & CROCKETT
Entity type:Organization
Organization Name:BASILIERE & CROCKETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BASILIERE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:714-595-4661
Mailing Address - Street 1:4520 INTELCO LOOP SE BLDG 3
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-6008
Mailing Address - Country:US
Mailing Address - Phone:360-972-2524
Mailing Address - Fax:360-972-2526
Practice Address - Street 1:4520 INTELCO LOOP SE BLDG 3
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6008
Practice Address - Country:US
Practice Address - Phone:360-972-2524
Practice Address - Fax:360-972-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty