Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2428 | TN |
N | 111NP0017X | Pediatric Chiropractor | 2428 | TN |
NPI | 1720397730 |
---|---|
Provider Name | Dr. Randall Jay Crawford |
First Address | Crossville, TN 38555-6187 |
Second Address | Crossville, TN 38555-6187 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2010 |
Last Update Date | 24/09/2015 |