Provider Demographics
NPI:1073738522
Name:CROWLEY CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:CROWLEY CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:912-265-2129
Mailing Address - Street 1:597 PALISADE DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-8208
Mailing Address - Country:US
Mailing Address - Phone:912-265-2129
Mailing Address - Fax:912-265-2605
Practice Address - Street 1:597 PALISADE DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31523-8208
Practice Address - Country:US
Practice Address - Phone:912-265-2129
Practice Address - Fax:912-265-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005978111N00000X
GACHIR006507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty