Provider Demographics
NPI:1558395871
Name:MCCRUM, RACHAEL S (DC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:S
Last Name:MCCRUM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 WARREN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-4483
Mailing Address - Country:US
Mailing Address - Phone:540-622-6400
Mailing Address - Fax:540-622-6401
Practice Address - Street 1:316 WARREN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-4483
Practice Address - Country:US
Practice Address - Phone:540-622-6400
Practice Address - Fax:540-622-6401
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA197577OtherBLUE SHIELD INSURANCE
VAU89481Medicare UPIN