Provider Demographics
NPI:1598215568
Name:CRANE, ROBERT (LAC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CRANE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 BROADWAY ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2627
Mailing Address - Country:US
Mailing Address - Phone:612-378-6037
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON AVE N
Practice Address - Street 2:SUITE 190
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-1330
Practice Address - Country:US
Practice Address - Phone:612-999-5894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1767171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist