Provider Demographics
NPI:1740465491
Name:HALCROW CHIROPRACTIC & MASSAGE, PC
Entity type:Organization
Organization Name:HALCROW CHIROPRACTIC & MASSAGE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:HALCROW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-280-1885
Mailing Address - Street 1:20690 RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-280-1885
Mailing Address - Fax:541-318-7019
Practice Address - Street 1:365 NE GREENWOOD AVE
Practice Address - Street 2:STE 2
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4628
Practice Address - Country:US
Practice Address - Phone:541-312-4400
Practice Address - Fax:541-318-7019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3019261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR106650Medicare PIN