Provider Demographics
NPI:1962500017
Name:CROUCHER, ERIC EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:EDWARD
Last Name:CROUCHER
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 1:136 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2720
Mailing Address - Country:US
Mailing Address - Phone:315-635-2333
Mailing Address - Fax:315-635-3945
Practice Address - Street 1:138 E. GENESEE ST.
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2720
Practice Address - Country:US
Practice Address - Phone:315-635-2333
Practice Address - Fax:315-635-3945
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006586-1111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA1495OtherMEDICARE PTAN
DD4221Medicare PIN
NYU18434Medicare UPIN