Provider Demographics
NPI:1992299481
Name:CRUM, KENNETH E (DC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:CRUM
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 1:4400 E CALLAHAN RD
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:CA
Mailing Address - Zip Code:96027-9776
Mailing Address - Country:US
Mailing Address - Phone:530-966-0332
Mailing Address - Fax:
Practice Address - Street 1:4400 E CALLAHAN RD
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:CA
Practice Address - Zip Code:96027-9776
Practice Address - Country:US
Practice Address - Phone:530-966-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor