Provider Demographics
NPI:1770677825
Name:MICHAEL H CROSBIE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MICHAEL H CROSBIE CHIROPRACTIC INC
Other - Org Name:CROSBIE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:CROSBIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-725-5668
Mailing Address - Street 1:1828 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-2717
Mailing Address - Country:US
Mailing Address - Phone:707-725-5668
Mailing Address - Fax:
Practice Address - Street 1:1828 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-2717
Practice Address - Country:US
Practice Address - Phone:707-725-5668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC145801Medicare PIN
CA1770677825Medicare NSC
CA1770677825Medicare Oscar/Certification
CAZZZ04199ZMedicare UPIN