Provider Demographics
NPI:1639172307
Name:CROSBY, BING G (DC)
Entity Type:Individual
Prefix:DR
First Name:BING
Middle Name:G
Last Name:CROSBY
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 1:4508 OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3857
Mailing Address - Country:US
Mailing Address - Phone:502-969-3121
Mailing Address - Fax:502-969-4570
Practice Address - Street 1:4508 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3857
Practice Address - Country:US
Practice Address - Phone:502-969-3121
Practice Address - Fax:502-969-4570
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3133-R111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85031334Medicaid
KY000000052061OtherANTHEM BCBS
KY85031334Medicaid
KY6006901Medicare ID - Type Unspecified