Healthcare Provider Details

I. General information

NPI: 1144387994
Provider Name (Legal Business Name): ROBERT CRANDOL SPAIN JR. D.C., M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 02/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 PROVIDENCE ST
WHITEHOUSE OH
43571-9273
US

IV. Provider business mailing address

6901 PROVIDENCE ST
WHITEHOUSE OH
43571-9273
US

V. Phone/Fax

Practice location:
  • Phone: 419-877-9919
  • Fax: 419-877-9977
Mailing address:
  • Phone: 419-877-9919
  • Fax: 419-877-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE0001922
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3982
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: