Healthcare Provider Details

I. General information

NPI: 1669125423
Provider Name (Legal Business Name): JACOB CRAWSHAW CSCS, CNC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 N SPEER BLVD UNIT 101
DENVER CO
80211-4215
US

IV. Provider business mailing address

2828 N SPEER BLVD UNIT 101
DENVER CO
80211-4215
US

V. Phone/Fax

Practice location:
  • Phone: 904-814-3091
  • Fax:
Mailing address:
  • Phone: 904-814-4309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number7248034595
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: