Provider Demographics
NPI:1225119837
Name:CRAWFORD, IRA JEREMY (DC)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:JEREMY
Last Name:CRAWFORD
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 1:1177 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84335-6764
Mailing Address - Country:US
Mailing Address - Phone:435-563-6887
Mailing Address - Fax:
Practice Address - Street 1:1177 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84335-6764
Practice Address - Country:US
Practice Address - Phone:435-563-6887
Practice Address - Fax:435-535-0769
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT368408-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012535OtherMEDICARE PTAN
ID8062848Medicaid
UTU73957Medicare UPIN