Provider Demographics
NPI:1972527679
Name:CROMSHAW, GILBERT DEITZ (DC)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:DEITZ
Last Name:CROMSHAW
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:PO BOX 1378
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-1378
Mailing Address - Country:US
Mailing Address - Phone:910-371-2525
Mailing Address - Fax:910-371-5922
Practice Address - Street 1:304 VILLAGE ROAD
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-1378
Practice Address - Country:US
Practice Address - Phone:910-371-2525
Practice Address - Fax:910-371-5922
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790183LMedicaid
NC790183LMedicaid
NC2448967AMedicare ID - Type Unspecified