Provider Demographics
NPI:1023038940
Name:CRAWFORD, CHRISTINE JENNIFER (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:JENNIFER
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:JENNIFER
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:19207 COACHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7882
Mailing Address - Country:US
Mailing Address - Phone:734-479-0614
Mailing Address - Fax:
Practice Address - Street 1:7780 MACOMB ST
Practice Address - Street 2:
Practice Address - City:GROSSE ILE
Practice Address - State:MI
Practice Address - Zip Code:48138-2201
Practice Address - Country:US
Practice Address - Phone:734-934-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4712948Medicaid
MI4712948Medicaid