Provider Demographics
NPI:1851691919
Name:CROUCH, ALBA RUTH (LMP,CNA)
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:RUTH
Last Name:CROUCH
Suffix:
Gender:F
Credentials:LMP,CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98083-0011
Mailing Address - Country:US
Mailing Address - Phone:425-825-7518
Mailing Address - Fax:
Practice Address - Street 1:10547 GREENWOOD AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8720
Practice Address - Country:US
Practice Address - Phone:206-362-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60071010111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation