Healthcare Provider Details

I. General information

NPI: 1386712263
Provider Name (Legal Business Name): JOSEPH MARK CRUM DC, CCRD, CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 COMMONWEALTH AVE STE 120
BRISTOL VA
24201-3868
US

IV. Provider business mailing address

359 COMMONWEALTH AVE STE 120
BRISTOL VA
24201-3868
US

V. Phone/Fax

Practice location:
  • Phone: 276-669-0969
  • Fax: 276-669-0969
Mailing address:
  • Phone: 276-669-0969
  • Fax: 276-669-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104001471
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: