Provider Demographics
NPI:1114096211
Name:CROOKER, JONATHAN CAMERON (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CAMERON
Last Name:CROOKER
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 1:937 E HAVERFORD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3800
Mailing Address - Country:US
Mailing Address - Phone:610-520-2490
Mailing Address - Fax:610-520-2492
Practice Address - Street 1:937 E HAVERFORD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3800
Practice Address - Country:US
Practice Address - Phone:610-520-2490
Practice Address - Fax:610-520-2492
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009554111NS0005X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA273309601OtherTAX IDENIFICATION NUMBER
PA135847Medicare PIN