MEDICARE: CREWS CHIROPRACTIC 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	CH9585	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH9585	OTHER	FL	FLORIDA MEDICAL LICENSE

General Provider Information

NPI Number	:	1891938346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREWS CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	1365 BEVILLE RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1529
Country	:	US
Telephone Number	:	386-846-3467
Fax Number	:	386-269-1209

Provider Business Practice Location Address
First Line	:	1365 BEVILLE RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32119-1529
Country	:	US
Telephone Number	:	386-846-3467
Fax Number	:	386-269-1209

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	DR. BRANDON L CREWS
Credential	:	D.C.
Telephone Number	:	386-492-7963

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	04/23/2009

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Directions to “CREWS CHIROPRACTIC PA ” Practice Location

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