Provider Demographics
NPI:1235121898
Name:CROSSLAND, MAURICE NEIL (DC)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:NEIL
Last Name:CROSSLAND
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 1:207 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3304
Mailing Address - Country:US
Mailing Address - Phone:641-472-4454
Mailing Address - Fax:
Practice Address - Street 1:207 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3304
Practice Address - Country:US
Practice Address - Phone:641-472-4454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0149294Medicaid
IA0149294Medicaid