MEDICARE: DR. TREVOR CROSSLEY 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	33819	CA

General Provider Information

NPI Number	:	1679014922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREVOR CROSSLEY D.C.

Provider Business Mailing Address
First Line	:	736 W 4TH AVE
Second Line	:
City	:	LA HABRA
State	:	CA
Zip	:	90631-6012
Country	:	US
Telephone Number	:	760-500-3570
Fax Number	:

Provider Business Practice Location Address
First Line	:	9625 BLACK MOUNTAIN RD
Second Line	:	STE 208
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4598
Country	:	US
Telephone Number	:	858-634-2225
Fax Number	:

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

Provider Enumeration Date	:	03/19/2017
Last Update Date	:	01/07/2020

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