Provider Demographics
NPI:1205853702
Name:CROSBIE, MICHAEL HENRY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HENRY
Last Name:CROSBIE
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 1:1828 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-2717
Mailing Address - Country:US
Mailing Address - Phone:707-725-5668
Mailing Address - Fax:707-725-8802
Practice Address - Street 1:1828 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-2717
Practice Address - Country:US
Practice Address - Phone:707-725-5668
Practice Address - Fax:707-725-8802
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2878101OtherST OF CA CORP ID
CADC14580OtherBOARD OF CHIROPRACTIC EXA
CADC14580OtherBOARD OF CHIROPRACTIC EXA
CA2878101OtherST OF CA CORP ID