Healthcare Provider Details

I. General information

NPI: 1407154792
Provider Name (Legal Business Name): MCCRUM FAMILY CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1832 OAK HOLLOW DR SUITE B
TRAVERSE CITY MI
49686-5902
US

IV. Provider business mailing address

1832 OAK HOLLOW DR SUITE B
TRAVERSE CITY MI
49686-5902
US

V. Phone/Fax

Practice location:
  • Phone: 231-995-0990
  • Fax: 231-995-0991
Mailing address:
  • Phone: 231-995-0990
  • Fax: 231-995-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009684
License Number StateMI

VIII. Authorized Official

Name: DR. CHRISTA CHERI MCCRUM
Title or Position: OWNER
Credential: D.C.
Phone: 231-995-0990