Provider Demographics
NPI:1245410380
Name:CRUTH ENTERPRISES, INC.
Entity Type:Organization
Organization Name:CRUTH ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWENER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-543-6996
Mailing Address - Street 1:5407 4TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-4348
Mailing Address - Country:US
Mailing Address - Phone:806-549-6696
Mailing Address - Fax:806-791-3934
Practice Address - Street 1:5407 4TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-4348
Practice Address - Country:US
Practice Address - Phone:806-549-6696
Practice Address - Fax:806-791-3934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U93118Medicare UPIN