Provider Demographics
NPI:1306400767
Name:CROUSE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:CROUSE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-999-9664
Mailing Address - Street 1:5303 W AIRE LIBRE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1914
Mailing Address - Country:US
Mailing Address - Phone:602-999-9664
Mailing Address - Fax:
Practice Address - Street 1:5303 W AIRE LIBRE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1914
Practice Address - Country:US
Practice Address - Phone:602-999-9664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty