Provider Demographics
NPI:1689728206
Name:CROSBY, JONATHAN BRETT (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BRETT
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 1:608 N MARABLE ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-3032
Mailing Address - Country:US
Mailing Address - Phone:318-281-0550
Mailing Address - Fax:318-283-1883
Practice Address - Street 1:608 N MARABLE ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-3032
Practice Address - Country:US
Practice Address - Phone:318-281-0550
Practice Address - Fax:318-283-1883
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4K782DH05Medicare PIN