Healthcare Provider Details

I. General information

NPI: 1073502795
Provider Name (Legal Business Name): LAWRENCE LANDON CRAWFORD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 SALEM CT
TALLAHASSEE FL
32301-2809
US

IV. Provider business mailing address

137 SALEM CT
TALLAHASSEE FL
32301-2809
US

V. Phone/Fax

Practice location:
  • Phone: 850-878-2363
  • Fax: 850-878-2281
Mailing address:
  • Phone: 850-878-2363
  • Fax: 850-878-2281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH1594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: