Provider Demographics
NPI:1255328472
Name:CRAWFORD, MICHELLE MARTY (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARTY
Last Name:CRAWFORD
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 1:101 MARTY DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-9303
Mailing Address - Country:US
Mailing Address - Phone:763-682-4000
Mailing Address - Fax:
Practice Address - Street 1:101 MARTY DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-9303
Practice Address - Country:US
Practice Address - Phone:763-682-4000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U65100Medicare UPIN