Provider Demographics
NPI:1073510160
Name:CREWS, CARL RODNEY JR (DC)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:RODNEY
Last Name:CREWS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RODNEY
Other - Middle Name:
Other - Last Name:CREWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:915 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2103
Mailing Address - Country:US
Mailing Address - Phone:318-220-7688
Mailing Address - Fax:318-220-7690
Practice Address - Street 1:915 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2103
Practice Address - Country:US
Practice Address - Phone:318-220-7688
Practice Address - Fax:318-220-7690
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1343111N00000X
TX9556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1306033493Medicare PIN
LA1073510160Medicare PIN