Provider Demographics
NPI:1790708402
Name:CRAWFORD, MARY ANNE (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANNE
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:718 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-2605
Mailing Address - Country:US
Mailing Address - Phone:717-244-8504
Mailing Address - Fax:717-244-5401
Practice Address - Street 1:718 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-2605
Practice Address - Country:US
Practice Address - Phone:717-244-8504
Practice Address - Fax:717-244-5401
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002834L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50041910OtherCAPITAL BLUE CROSS
PA4403296OtherAETNA
PA50041910OtherCAPITAL BLUE CROSS
PAT30528Medicare UPIN