Healthcare Provider Details

I. General information

NPI: 1326140955
Provider Name (Legal Business Name): PAUL RAYMOND CROWE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 LUDINGTON ST
ESCANABA MI
49829-2840
US

IV. Provider business mailing address

810 N 18TH ST
ESCANABA MI
49829-1520
US

V. Phone/Fax

Practice location:
  • Phone: 906-786-0400
  • Fax:
Mailing address:
  • Phone: 906-786-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2301008769
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: