MEDICARE: TY CROUCH DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	15834	FL

General Provider Information

NPI Number	:	1477400455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TY CROUCH DC

Provider Business Mailing Address
First Line	:	3038 SUNRISE BLVD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-6113
Country	:	US
Telephone Number	:	772-979-4615
Fax Number	:

Provider Business Practice Location Address
First Line	:	1680 SE LYNGATE DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-4300
Country	:	US
Telephone Number	:	772-773-7055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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Directions to “ TY CROUCH DC” Practice Location

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