Provider Demographics
NPI:1790856607
Name:CRAWFORD, JARED EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:EDWARD
Last Name:CRAWFORD
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 1:55 S STATE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-3827
Mailing Address - Country:US
Mailing Address - Phone:317-638-3111
Mailing Address - Fax:
Practice Address - Street 1:823 N LELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4324
Practice Address - Country:US
Practice Address - Phone:513-225-1400
Practice Address - Fax:513-225-1400
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002261A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor