Healthcare Provider Details

I. General information

NPI: 1144661646
Provider Name (Legal Business Name): ANDREW THOMAS CRAPO RAC, MSTOM, DIPL. OM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3368 E BELTLINE CT NE
GRAND RAPIDS MI
49525-9480
US

IV. Provider business mailing address

1902 R W BERENDS DR SW APT. 12
WYOMING MI
49519-6527
US

V. Phone/Fax

Practice location:
  • Phone: 616-855-7718
  • Fax:
Mailing address:
  • Phone: 269-830-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5401000101
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: