Provider Demographics
NPI:1770513350
Name:CRAWFORD, BRIAN WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WAYNE
Last Name:CRAWFORD
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 1:2027 W MARCH LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6418
Mailing Address - Country:US
Mailing Address - Phone:209-474-2252
Mailing Address - Fax:209-474-1497
Practice Address - Street 1:2027 W MARCH LN
Practice Address - Street 2:SUITE 1
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6418
Practice Address - Country:US
Practice Address - Phone:209-474-2252
Practice Address - Fax:209-474-1497
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor