Provider Demographics
NPI:1295937886
Name:CRUM, VICKI LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:LYNN
Last Name:CRUM
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 1:7651 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7972
Mailing Address - Country:US
Mailing Address - Phone:317-272-7988
Mailing Address - Fax:317-272-7918
Practice Address - Street 1:7651 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7972
Practice Address - Country:US
Practice Address - Phone:317-272-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002326A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200955530AMedicaid
IN261860Medicare PIN