Provider Demographics
NPI:1679014922
Name:CROSSLEY, TREVOR (DC)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:
Last Name:CROSSLEY
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 1:736 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6012
Mailing Address - Country:US
Mailing Address - Phone:760-500-3570
Mailing Address - Fax:
Practice Address - Street 1:9625 BLACK MOUNTAIN RD
Practice Address - Street 2:STE 208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4598
Practice Address - Country:US
Practice Address - Phone:858-634-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-19
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor