Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 301 | RI |
N | 225100000X | Physical Therapist | 905 | RI |
NPI | 1003828377 |
---|---|
Provider Name | Dr. Andrew T Crellin |
First Address | West Warwick, RI 02893-2248 |
Second Address | West Warwick, RI 02893-2248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 11/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004675 | BLUE CHIP (01) | RI |
35066 | BLUE CROSS (01) | |
4400163 | UH (01) | |
T92415 | (02) |