Provider Demographics
NPI:1598850315
Name:CROUCH, ERIC ALVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALVIN
Last Name:CROUCH
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 1:413 GREENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-3360
Mailing Address - Country:US
Mailing Address - Phone:706-812-2225
Mailing Address - Fax:706-812-8966
Practice Address - Street 1:413 GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3360
Practice Address - Country:US
Practice Address - Phone:706-812-2225
Practice Address - Fax:706-812-8966
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU67444Medicare UPIN
GA35ZCDXMMedicare PIN