Provider Demographics
NPI:1306033493
Name:CREWS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:CREWS CHIROPRACTIC, INC.
Other - Org Name:CREWS ACCIDENT & INJURY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:318-220-7688
Mailing Address - Street 1:2210 LINE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2152
Mailing Address - Country:US
Mailing Address - Phone:318-220-7688
Mailing Address - Fax:318-220-7690
Practice Address - Street 1:2210 LINE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2152
Practice Address - Country:US
Practice Address - Phone:318-220-7688
Practice Address - Fax:318-220-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty