Provider Demographics
NPI:1821142035
Name:CROWLEY, GREGORY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOHN
Last Name:CROWLEY
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 1:605 MELINDA DR
Mailing Address - Street 2:
Mailing Address - City:PEOSTA
Mailing Address - State:IA
Mailing Address - Zip Code:52068-9698
Mailing Address - Country:US
Mailing Address - Phone:563-580-7635
Mailing Address - Fax:
Practice Address - Street 1:5555 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:ASBURY
Practice Address - State:IA
Practice Address - Zip Code:52002-2508
Practice Address - Country:US
Practice Address - Phone:563-582-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA17417OtherWELLMARK
IAI20306Medicare PIN