Provider Demographics
NPI:1891938346
Name:CREWS CHIROPRACTIC PA
Entity type:Organization
Organization Name:CREWS CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-492-7963
Mailing Address - Street 1:1365 BEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1529
Mailing Address - Country:US
Mailing Address - Phone:386-846-3467
Mailing Address - Fax:386-269-1209
Practice Address - Street 1:1365 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32119-1529
Practice Address - Country:US
Practice Address - Phone:386-846-3467
Practice Address - Fax:386-269-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH9585OtherFLORIDA MEDICAL LICENSE