Provider Demographics
NPI:1588712061
Name:CROSSGROVE, NAN J (DC)
Entity type:Individual
Prefix:DR
First Name:NAN
Middle Name:J
Last Name:CROSSGROVE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 HERR LN
Mailing Address - Street 2:STE. 201
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4376
Mailing Address - Country:US
Mailing Address - Phone:502-426-7356
Mailing Address - Fax:502-426-7356
Practice Address - Street 1:1315 HERR LN
Practice Address - Street 2:STE. 201
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4376
Practice Address - Country:US
Practice Address - Phone:502-426-7356
Practice Address - Fax:502-426-7356
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor