Provider Demographics
NPI:1669897880
Name:C M CRAWFORD CHIROPRACTIC LLC
Entity type:Organization
Organization Name:C M CRAWFORD CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL JAMES
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-237-3141
Mailing Address - Street 1:1749 INDEPENDENCE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5903
Mailing Address - Country:US
Mailing Address - Phone:573-339-0220
Mailing Address - Fax:
Practice Address - Street 1:1749 INDEPENDENCE ST
Practice Address - Street 2:SUITE E
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5903
Practice Address - Country:US
Practice Address - Phone:573-339-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014000792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty