Provider Demographics
NPI:1093380842
Name:CREWS, ANDREW GRADY (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:GRADY
Last Name:CREWS
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 1:1318 DAVIE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3565
Mailing Address - Country:US
Mailing Address - Phone:828-221-6259
Mailing Address - Fax:
Practice Address - Street 1:1318 DAVIE AVE STE B
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3565
Practice Address - Country:US
Practice Address - Phone:828-221-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5278OtherNC STATE BOARD OF CHIROPRACTIC EXAMINERS