Provider Demographics
NPI:1245311315
Name:CROFCHICK, BENJAMIN (DC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:CROFCHICK
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 1:8 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MI
Mailing Address - Zip Code:49082-1186
Mailing Address - Country:US
Mailing Address - Phone:352-476-5968
Mailing Address - Fax:
Practice Address - Street 1:8 N MAIN ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MI
Practice Address - Zip Code:49082-1186
Practice Address - Country:US
Practice Address - Phone:352-476-5968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4792822Medicaid
MIU79857Medicare UPIN
MI4792822Medicaid