Provider Demographics
NPI:1528280369
Name:CRUTCHFIED, BRYAN E (DC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:E
Last Name:CRUTCHFIED
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 1:15 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGGINSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64037-1521
Mailing Address - Country:US
Mailing Address - Phone:660-584-7131
Mailing Address - Fax:660-584-2034
Practice Address - Street 1:15 E 19TH ST
Practice Address - Street 2:
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037-1521
Practice Address - Country:US
Practice Address - Phone:660-584-7131
Practice Address - Fax:660-584-2034
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO43-1811506OtherTAX ID
KS0006364Medicare ID - Type Unspecified
MO43-1811506OtherTAX ID