Provider Demographics
NPI:1326140955
Name:CROWE, PAUL RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RAYMOND
Last Name:CROWE
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 1:810 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1520
Mailing Address - Country:US
Mailing Address - Phone:906-786-6789
Mailing Address - Fax:
Practice Address - Street 1:1616 LUDINGTON ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-2840
Practice Address - Country:US
Practice Address - Phone:906-786-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008769111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI67900Medicare ID - Type Unspecified