Healthcare Provider Details

I. General information

NPI: 1881511202
Provider Name (Legal Business Name): CHRISTOPHER CRAWFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 DELAMERE AVE
RACINE WI
53403-1627
US

IV. Provider business mailing address

1005 DELAMERE AVE
RACINE WI
53403-1627
US

V. Phone/Fax

Practice location:
  • Phone: 920-544-6284
  • Fax:
Mailing address:
  • Phone: 920-544-6284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberC6161048425605
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: