Provider Demographics
NPI:1952109811
Name:CROCKETT, JUSTICE (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTICE
Middle Name:
Last Name:CROCKETT
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21618 SANDYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-8153
Mailing Address - Country:US
Mailing Address - Phone:985-710-3995
Mailing Address - Fax:
Practice Address - Street 1:2626 S LOOP W STE 645
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2693
Practice Address - Country:US
Practice Address - Phone:985-710-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor