Healthcare Provider Details

I. General information

NPI: 1659479426
Provider Name (Legal Business Name): JOHN W. CRAWFORD JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W SYLVANIA AVE
NEPTUNE CITY NJ
07753-6428
US

IV. Provider business mailing address

108 W SYLVANIA AVE
NEPTUNE CITY NJ
07753-6428
US

V. Phone/Fax

Practice location:
  • Phone: 732-774-1880
  • Fax: 732-774-9094
Mailing address:
  • Phone: 732-774-1880
  • Fax: 732-774-9094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number160
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00252700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: