MEDICARE: RANDAL L CRABTREE D C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC8675	TX

General Provider Information

NPI Number	:	1396763637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDAL L CRABTREE D C

Provider Business Mailing Address
First Line	:	6275 OLD GRANBURY RD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76133-3401
Country	:	US
Telephone Number	:	817-263-2922
Fax Number	:	817-263-6640

Provider Business Practice Location Address
First Line	:	6275 GRANBURY RD.
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76133-3401
Country	:	US
Telephone Number	:	817-263-2922
Fax Number	:	817-263-6640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	10/31/2007

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