Provider Demographics
NPI:1770522518
Name:CRAIN, KEVIN RYN (DC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RYN
Last Name:CRAIN
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 1:104 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-2378
Mailing Address - Country:US
Mailing Address - Phone:248-685-7700
Mailing Address - Fax:248-685-7740
Practice Address - Street 1:104 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-2378
Practice Address - Country:US
Practice Address - Phone:248-685-7700
Practice Address - Fax:248-685-7740
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF35151OtherCHIROPRACTOR