Provider Demographics
NPI:1083606578
Name:CRUME, BRIAN D (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:CRUME
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 1:1756 CONTINENTAL ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1240
Mailing Address - Country:US
Mailing Address - Phone:530-244-4772
Mailing Address - Fax:530-244-1118
Practice Address - Street 1:1756 CONTINENTAL ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1240
Practice Address - Country:US
Practice Address - Phone:530-244-4772
Practice Address - Fax:530-244-1118
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0180740Medicaid
CADC0180740Medicare ID - Type Unspecified
CADC0180740Medicaid