Provider Demographics
NPI:1275248718
Name:CRUM CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:CRUM CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-966-0332
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:CA
Mailing Address - Zip Code:96027-0860
Mailing Address - Country:US
Mailing Address - Phone:530-461-5600
Mailing Address - Fax:
Practice Address - Street 1:435 MAIN ST.
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:CA
Practice Address - Zip Code:96027
Practice Address - Country:US
Practice Address - Phone:530-467-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty