Provider Demographics
NPI:1386712263
Name:CRUM, JOSEPH MARK (DC, CCRD, CCSP)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARK
Last Name:CRUM
Suffix:
Gender:M
Credentials:DC, CCRD, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COMMONWEALTH AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3831
Mailing Address - Country:US
Mailing Address - Phone:276-669-0969
Mailing Address - Fax:
Practice Address - Street 1:111 COMMONWEALTH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3831
Practice Address - Country:US
Practice Address - Phone:276-669-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001471111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5697482OtherAETNA
VA241832OtherBCBS OF VA
TN3040218OtherBCBS OF TN
VA2116065OtherMAMSI
VA5697482OtherAETNA