Provider Demographics
NPI:1407154792
Name:MCCRUM FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:MCCRUM FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:CHERI
Authorized Official - Last Name:MCCRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-995-0990
Mailing Address - Street 1:1832 OAK HOLLOW DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-5902
Mailing Address - Country:US
Mailing Address - Phone:231-995-0990
Mailing Address - Fax:231-995-0991
Practice Address - Street 1:1832 OAK HOLLOW DR
Practice Address - Street 2:SUITE B
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-5902
Practice Address - Country:US
Practice Address - Phone:231-995-0990
Practice Address - Fax:231-995-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty