Provider Demographics
NPI:1366410458
Name:CROWLEY, JEFFREY LAWRENCE (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LAWRENCE
Last Name:CROWLEY
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 1:8546 CRESCENT BEACH RD
Mailing Address - Street 2:
Mailing Address - City:PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:48755-9711
Mailing Address - Country:US
Mailing Address - Phone:989-586-2988
Mailing Address - Fax:989-856-2988
Practice Address - Street 1:6827 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:CASEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48725-9542
Practice Address - Country:US
Practice Address - Phone:989-856-4187
Practice Address - Fax:989-856-2118
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P236000Medicare ID - Type Unspecified