Provider Demographics
NPI:1962665778
Name:B.CRAWFORD CHIROPRACTIC, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:B.CRAWFORD CHIROPRACTIC, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-945-3232
Mailing Address - Street 1:9640 CENTER AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5809
Mailing Address - Country:US
Mailing Address - Phone:909-945-3232
Mailing Address - Fax:909-945-3220
Practice Address - Street 1:9640 CENTER AVE STE 120
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5809
Practice Address - Country:US
Practice Address - Phone:909-945-3232
Practice Address - Fax:909-945-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18771111N00000X
CA5398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty