Provider Demographics
NPI:1972790368
Name:CREWS, DANIEL MICHAEL (DC, DACBN)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MICHAEL
Last Name:CREWS
Suffix:
Gender:M
Credentials:DC, DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1722
Mailing Address - Country:US
Mailing Address - Phone:631-656-9730
Mailing Address - Fax:
Practice Address - Street 1:267 E MAIN ST
Practice Address - Street 2:BLDG B
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2874
Practice Address - Country:US
Practice Address - Phone:631-656-9730
Practice Address - Fax:631-656-9729
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008068111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU65045Medicare UPIN
NYX70432Medicare PIN