Healthcare Provider Details

I. General information

NPI: 1902268956
Provider Name (Legal Business Name): JOHN R CRUTCHFIELD BOCO, BOCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N CHURCH ST
GREENSBORO NC
27405-4309
US

IV. Provider business mailing address

2301 N CHURCH ST
GREENSBORO NC
27405-4309
US

V. Phone/Fax

Practice location:
  • Phone: 336-333-9081
  • Fax:
Mailing address:
  • Phone: 336-333-9081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: