MEDICARE: PAUL CROW DC LLC

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	DC0000001947	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3971257	OTHER	TN	MEDICARE

General Provider Information

NPI Number	:	1942496401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL CROW DC LLC

Provider Business Mailing Address
First Line	:	255 DOVER RD
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-4155
Country	:	US
Telephone Number	:	931-906-2055
Fax Number	:	931-906-2172

Provider Business Practice Location Address
First Line	:	255 DOVER RD
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-4155
Country	:	US
Telephone Number	:	931-906-2055
Fax Number	:	931-906-2172

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	RHONDA CROW
Credential	:
Telephone Number	:	931-906-2055

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	10/04/2011

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Directions to “PAUL CROW DC LLC ” Practice Location

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