Provider Demographics
NPI:1457544959
Name:CROCKFORD, ROBERT J (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:CROCKFORD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:68 GLOBAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4628
Mailing Address - Country:US
Mailing Address - Phone:864-644-2700
Mailing Address - Fax:864-644-2709
Practice Address - Street 1:123 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-9369
Practice Address - Country:US
Practice Address - Phone:864-949-5550
Practice Address - Fax:864-949-5551
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3281Medicaid
SCAA22428844Medicare PIN