Provider Demographics
NPI:1699896449
Name:CROCETTO CHIROPRACTIC CENTER, P.C.
Entity type:Organization
Organization Name:CROCETTO CHIROPRACTIC CENTER, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CROCETTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-264-1699
Mailing Address - Street 1:1114 S WINTER ST STE 7
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-4292
Mailing Address - Country:US
Mailing Address - Phone:517-264-1699
Mailing Address - Fax:
Practice Address - Street 1:1114 S WINTER ST STE 7
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-4292
Practice Address - Country:US
Practice Address - Phone:517-264-1699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D65028Medicare UPIN
MI0N79990Medicare ID - Type UnspecifiedMEDICARE