Provider Demographics
NPI:1003828377
Name:CRELLIN, ANDREW T (DC RPT)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:T
Last Name:CRELLIN
Suffix:
Gender:M
Credentials:DC RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 COWESETT AVE
Mailing Address - Street 2:STE 7
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-2248
Mailing Address - Country:US
Mailing Address - Phone:401-615-5200
Mailing Address - Fax:401-821-1880
Practice Address - Street 1:328 COWESETT AVE
Practice Address - Street 2:STE 7
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-2248
Practice Address - Country:US
Practice Address - Phone:401-615-5200
Practice Address - Fax:401-821-1880
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI905225100000X
RI301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
35066OtherBLUE CROSS
4400163OtherUH
RI004675OtherBLUE CHIP
T92415Medicare UPIN