Provider Demographics
NPI:1316983067
Name:CROUCHLEY, MICHAEL P (DC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:CROUCHLEY
Suffix:
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 1:21 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2834
Mailing Address - Country:US
Mailing Address - Phone:860-665-0001
Mailing Address - Fax:860-665-0003
Practice Address - Street 1:21 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2834
Practice Address - Country:US
Practice Address - Phone:860-665-0001
Practice Address - Fax:860-665-0003
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000748CT01OtherBCBS
CT050000748CT01OtherBCBS
CT350000581Medicare ID - Type Unspecified