Provider Demographics
NPI:1811987852
Name:CRUM, GARY ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLEN
Last Name:CRUM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 MAHONING AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-2616
Mailing Address - Country:US
Mailing Address - Phone:330-793-1141
Mailing Address - Fax:440-943-5178
Practice Address - Street 1:32313 VINE ST
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-3341
Practice Address - Country:US
Practice Address - Phone:440-943-4357
Practice Address - Fax:440-943-5178
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0811590Medicaid
OHCR0683894Medicare ID - Type Unspecified
OH0811590Medicaid