Provider Demographics
NPI:1861432734
Name:CROUCHER, MARK D (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:CROUCHER
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 1:219 MCLAWS CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5649
Mailing Address - Country:US
Mailing Address - Phone:757-259-1122
Mailing Address - Fax:757-259-1123
Practice Address - Street 1:219 MCLAWS CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5649
Practice Address - Country:US
Practice Address - Phone:757-259-1122
Practice Address - Fax:757-259-1123
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007252111N00000X
VA1199111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA195038OtherANTHEM BLUE CROSS
VA7967114001OtherCIGNA