Provider Demographics
NPI:1396763637
Name:CRABTREE, RANDAL L (D C)
Entity type:Individual
Prefix:
First Name:RANDAL
Middle Name:L
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6275 OLD GRANBURY RD
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-3401
Mailing Address - Country:US
Mailing Address - Phone:817-263-2922
Mailing Address - Fax:817-263-6640
Practice Address - Street 1:6275 GRANBURY RD.
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-3401
Practice Address - Country:US
Practice Address - Phone:817-263-2922
Practice Address - Fax:817-263-6640
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611425Medicare ID - Type Unspecified