Provider Demographics
NPI:1003976812
Name:CRAWFORD, JEFFREY ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLEN
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 1:860 ANSONIA ST STE 116
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3187
Mailing Address - Country:US
Mailing Address - Phone:419-698-1555
Mailing Address - Fax:419-691-9583
Practice Address - Street 1:860 ANSONIA ST STE 116
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3187
Practice Address - Country:US
Practice Address - Phone:419-698-1555
Practice Address - Fax:419-691-9583
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2261467Medicaid
OHJESP04091Medicare ID - Type UnspecifiedINDIVIDUAL
OHCR4044662Medicare ID - Type UnspecifiedOFFICE
OHU84273Medicare UPIN