Provider Demographics
NPI:1245716000
Name:CRUTCHFIELD, JENA MAE (DC)
Entity type:Individual
Prefix:MS
First Name:JENA
Middle Name:MAE
Last Name:CRUTCHFIELD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 LUCERNE DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-3049
Mailing Address - Country:US
Mailing Address - Phone:734-846-4980
Mailing Address - Fax:
Practice Address - Street 1:203 DORIS DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1006
Practice Address - Country:US
Practice Address - Phone:863-646-0243
Practice Address - Fax:800-878-6125
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor