Provider Demographics
NPI:1033791249
Name:CRUMP, JEFFREY TANNER (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:TANNER
Last Name:CRUMP
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 1:508 FRANKLIN CT
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2152
Mailing Address - Country:US
Mailing Address - Phone:606-923-6208
Mailing Address - Fax:
Practice Address - Street 1:161 LEXINGTON GREEN CIR STE B15
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3379
Practice Address - Country:US
Practice Address - Phone:719-487-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY268716111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100782640Medicaid