=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285158196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY FIRST CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1420 3RD ST SE STE 202
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98372-3730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-256-4818
-----------------------------------------------------
Fax | 253-256-4819
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1420 3RD ST SE STE 202
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98372-3730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-256-4818
-----------------------------------------------------
Fax | 253-256-4819
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. DAVID LLOYD CROXFORD
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 864-814-9523
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH60272853
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111NN0400X
-----------------------------------------------------
Taxonomy Name | Neurology Chiropractor
-----------------------------------------------------
License Number | CH60272853
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------