Provider Demographics
NPI:1598257214
Name:CRANE, PHILIP BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:BRUCE
Last Name:CRANE
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 1:1801 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1880
Mailing Address - Country:US
Mailing Address - Phone:678-883-4957
Mailing Address - Fax:
Practice Address - Street 1:23 EASTBROOK BND STE 201
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1554
Practice Address - Country:US
Practice Address - Phone:678-883-6176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007537111N00000X
NJ38MC00477800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor