MEDICARE: CRANE CHIROPRACTIC PROFESSIONAL

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	1133	MT

General Provider Information

NPI Number	:	1689969180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRANE CHIROPRACTIC PROFESSIONAL

Provider Business Mailing Address
First Line	:	1400 16TH AVE SW
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-3134
Country	:	US
Telephone Number	:	406-590-5900
Fax Number	:	406-453-5197

Provider Business Practice Location Address
First Line	:	1400 16TH AVE SW
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-3134
Country	:	US
Telephone Number	:	406-590-5900
Fax Number	:	406-453-5197

Authorized Official
Title or Position	:	CEO
Name	:	TREVOR CRANE
Credential	:	D.C.
Telephone Number	:	406-590-5900

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	05/04/2016

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