Provider Demographics
NPI:1467675215
Name:CROUCH FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:CROUCH FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:T
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-842-1955
Mailing Address - Street 1:2709 NASHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4038
Mailing Address - Country:US
Mailing Address - Phone:270-842-1955
Mailing Address - Fax:270-842-1508
Practice Address - Street 1:2709 NASHVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4038
Practice Address - Country:US
Practice Address - Phone:270-842-1955
Practice Address - Fax:270-842-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4888111N00000X
KY4889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9589OtherMEDICARE GROUP
KY7100437030Medicaid