Provider Demographics
NPI:1144387994
Name:SPAIN, ROBERT CRANDOL JR (DC, MED)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CRANDOL
Last Name:SPAIN
Suffix:JR
Gender:M
Credentials:DC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 PROVIDENCE ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571-9273
Mailing Address - Country:US
Mailing Address - Phone:419-877-9919
Mailing Address - Fax:419-877-9977
Practice Address - Street 1:6901 PROVIDENCE ST
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:OH
Practice Address - Zip Code:43571-9273
Practice Address - Country:US
Practice Address - Phone:419-877-9919
Practice Address - Fax:419-877-9977
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001922101Y00000X
OH3982111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No101Y00000XBehavioral Health & Social Service ProvidersCounselor