Provider Demographics
NPI:1427015262
Name:CRUM, S BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:S BRIAN
Middle Name:
Last Name:CRUM
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 1:16 WOODLAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2139
Mailing Address - Country:US
Mailing Address - Phone:215-355-1144
Mailing Address - Fax:215-860-4136
Practice Address - Street 1:16 WOODLAKE DRIVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-2139
Practice Address - Country:US
Practice Address - Phone:215-355-1144
Practice Address - Fax:215-860-4136
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001559L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACR098070Medicare ID - Type Unspecified
T72714Medicare UPIN