MEDICARE: DR. BRANDON L CREWS 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	CH9585	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88797	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1932360328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON L CREWS D.C.

Provider Business Mailing Address
First Line	:	1365 BEVILLE RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 BEVILLE RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1529
Country	:	US
Telephone Number	:	386-492-7963
Fax Number	:

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

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	10/08/2009

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