Healthcare Provider Details

I. General information

NPI: 1639268030
Provider Name (Legal Business Name): THOMAS MICHAEL CREVAR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 E MAIN ST
BOWLING GREEN KY
42101-2255
US

IV. Provider business mailing address

544 E MAIN ST
BOWLING GREEN KY
42101-2255
US

V. Phone/Fax

Practice location:
  • Phone: 270-796-9316
  • Fax: 270-843-1877
Mailing address:
  • Phone: 270-796-9316
  • Fax: 270-843-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number4141
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: