Provider Demographics
NPI:1114016904
Name:CRONK, PAUL HENRY (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HENRY
Last Name:CRONK
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 1:217 ALBEMARLE AVENUE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4716
Mailing Address - Country:US
Mailing Address - Phone:540-344-6738
Mailing Address - Fax:540-344-8047
Practice Address - Street 1:217 ALBEMARLE AVENUE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4716
Practice Address - Country:US
Practice Address - Phone:540-344-6738
Practice Address - Fax:540-344-8047
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350000580Medicare ID - Type Unspecified
VAT21510Medicare UPIN