Provider Demographics
NPI:1164568523
Name:MASON, DAVID CRAWFORD (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CRAWFORD
Last Name:MASON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E BIG BEAVER RD
Mailing Address - Street 2:STE 400
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1216
Mailing Address - Country:US
Mailing Address - Phone:248-601-6100
Mailing Address - Fax:248-301-9574
Practice Address - Street 1:626 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1487
Practice Address - Country:US
Practice Address - Phone:248-601-6100
Practice Address - Fax:248-301-9574
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2107955Medicaid
MI450148Medicare UPIN
MI2107955Medicaid