MEDICARE: DR EVAN CRICHTON DC PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801543566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR EVAN CRICHTON DC PA

Provider Business Mailing Address
First Line	:	3316 CHIQUITA BLVD S STE 1
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-5111
Country	:	US
Telephone Number	:	239-800-5197
Fax Number	:

Provider Business Practice Location Address
First Line	:	3316 CHIQUITA BLVD S STE 1
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-5111
Country	:	US
Telephone Number	:	239-800-5197
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EVAN W CRICHTON
Credential	:	D.C.
Telephone Number	:	937-776-0601

Provider Enumeration Date	:	03/03/2022
Last Update Date	:	04/18/2024

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