Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | DC009554 | PA |
Y | 111NS0005X | Chiropractic Sports Physician | DC009554 | PA |
NPI | 1114096211 |
---|---|
Provider Name | Dr. Jonathan Cameron Crooker |
First Address | Bryn Mawr, PA 19010-3800 |
Second Address | Bryn Mawr, PA 19010-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 09/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
273309601 | TAX IDENIFICATION NUMBER (01) | PA |