Provider Demographics
NPI:1306844543
Name:CRENSHAW CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:CRENSHAW CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-634-3689
Mailing Address - Street 1:PO BOX 1681
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-1681
Mailing Address - Country:US
Mailing Address - Phone:928-634-3689
Mailing Address - Fax:928-634-7382
Practice Address - Street 1:544 S 6TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6142
Practice Address - Country:US
Practice Address - Phone:928-634-3689
Practice Address - Fax:928-634-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0931150OtherBLUE CROSS BLUE SHIELD
AZT41519Medicare UPIN
AZZ62919Medicare ID - Type Unspecified