Provider Demographics
NPI:1598956617
Name:CROWNBROOK INC
Entity Type:Organization
Organization Name:CROWNBROOK INC
Other - Org Name:HAWKINS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-495-9101
Mailing Address - Street 1:10267 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-4078
Mailing Address - Country:US
Mailing Address - Phone:801-495-9101
Mailing Address - Fax:801-523-9490
Practice Address - Street 1:10267 S 1300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-4078
Practice Address - Country:US
Practice Address - Phone:801-495-9101
Practice Address - Fax:801-523-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT93-268192-120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU44182Medicare UPIN