Provider Demographics
NPI:1902020696
Name:CROWLEY, TINA LOUISE (D C)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:LOUISE
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 PALISADE DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-8208
Mailing Address - Country:US
Mailing Address - Phone:912-265-2129
Mailing Address - Fax:912-265-2605
Practice Address - Street 1:597 PALISADE DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31523-8208
Practice Address - Country:US
Practice Address - Phone:912-265-2129
Practice Address - Fax:912-265-2605
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHLSMedicare ID - Type UnspecifiedMEDICARE NUMBER