Provider Demographics
NPI:1427656180
Name:ELAM-CROSLEY, LOGAN LAINE (ND, AEMT)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:LAINE
Last Name:ELAM-CROSLEY
Suffix:
Gender:M
Credentials:ND, AEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9140 WILDCAT RD
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-9211
Mailing Address - Country:US
Mailing Address - Phone:937-503-2165
Mailing Address - Fax:
Practice Address - Street 1:241 MILES AVE APT C
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1341
Practice Address - Country:US
Practice Address - Phone:937-503-2165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath