Provider Demographics
NPI:1396951562
Name:CROWLEY, L BRYCE (DC)
Entity type:Individual
Prefix:DR
First Name:L
Middle Name:BRYCE
Last Name:CROWLEY
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:PO BOX 613
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-0613
Mailing Address - Country:US
Mailing Address - Phone:801-294-6333
Mailing Address - Fax:801-294-8005
Practice Address - Street 1:1134 W 500 N
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1721
Practice Address - Country:US
Practice Address - Phone:801-294-6333
Practice Address - Fax:801-294-8005
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT317180-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor