Healthcare Provider Details

I. General information

NPI: 1811987852
Provider Name (Legal Business Name): GARY ALLEN CRUM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32313 VINE ST
WILLOWICK OH
44095-3341
US

IV. Provider business mailing address

3312 MAHONING AVE
YOUNGSTOWN OH
44509-2616
US

V. Phone/Fax

Practice location:
  • Phone: 440-943-4357
  • Fax: 440-943-5178
Mailing address:
  • Phone: 330-793-1141
  • Fax: 440-943-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1626
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: