Provider Demographics
NPI:1659479426
Name:CRAWFORD, JOHN W JR (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:CRAWFORD
Suffix:JR
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:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07754-0488
Mailing Address - Country:US
Mailing Address - Phone:732-774-1880
Mailing Address - Fax:732-774-9094
Practice Address - Street 1:72 W SYLVANIA AVE
Practice Address - Street 2:RT 35N
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-774-1880
Practice Address - Fax:732-774-9094
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00252700111N00000X
NJ160111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ589145Medicare PIN