Provider Demographics
NPI:1972510774
Name:CROWLEY, CORY GARRETT (DC)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:GARRETT
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 1:260 W MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3347
Mailing Address - Country:US
Mailing Address - Phone:615-264-8515
Mailing Address - Fax:615-264-8516
Practice Address - Street 1:260 W MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3347
Practice Address - Country:US
Practice Address - Phone:615-264-8515
Practice Address - Fax:615-264-8516
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC2013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNV05453Medicare UPIN
TN3973604Medicare ID - Type Unspecified