Healthcare Provider Details

I. General information

NPI: 1720397730
Provider Name (Legal Business Name): RANDALL JAY CRAWFORD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2010
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 INTERSTATE DR SUITE 101
CROSSVILLE TN
38555-6187
US

IV. Provider business mailing address

1364 INTERSTATE DR SUITE 101
CROSSVILLE TN
38555-6187
US

V. Phone/Fax

Practice location:
  • Phone: 931-456-8880
  • Fax: 931-456-8883
Mailing address:
  • Phone: 931-456-8880
  • Fax: 931-456-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number2428
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number277383
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2428
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: