Provider Demographics
NPI:1043291909
Name:CRAWFORD, CHERYL E (DC)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:E
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21539 ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:SHIPPENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16254-4041
Mailing Address - Country:US
Mailing Address - Phone:814-226-5540
Mailing Address - Fax:814-226-4940
Practice Address - Street 1:21539 ROUTE 66
Practice Address - Street 2:
Practice Address - City:SHIPPENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16254-4041
Practice Address - Country:US
Practice Address - Phone:814-226-5540
Practice Address - Fax:814-226-4940
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004640L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012867350003Medicaid
PA655320Medicare ID - Type Unspecified
PA0012867350003Medicaid