Healthcare Provider Details

I. General information

NPI: 1972790368
Provider Name (Legal Business Name): DANIEL MICHAEL CREWS D.C., D.A.C.B.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 E MAIN ST BLDG B
SMITHTOWN NY
11787-2874
US

IV. Provider business mailing address

23 NEWPORT AVE
SELDEN NY
11784-1722
US

V. Phone/Fax

Practice location:
  • Phone: 631-656-9730
  • Fax: 631-656-9729
Mailing address:
  • Phone: 631-656-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberX008068
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: