Provider Demographics
NPI:1972692671
Name:CRAWFORD, BRIAN BURNETT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:BURNETT
Last Name:CRAWFORD
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 1:2101 WINDSOR PL
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7769
Mailing Address - Country:US
Mailing Address - Phone:217-398-2225
Mailing Address - Fax:217-398-2224
Practice Address - Street 1:2101 WINDSOR PL
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7769
Practice Address - Country:US
Practice Address - Phone:217-398-2225
Practice Address - Fax:217-398-2224
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008791111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01022961OtherBCBS
IL01022961OtherBCBS