Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC008924 | PA |
NPI | 1104048602 |
---|---|
Provider Name | Mr. Michael Allen Crandall |
First Address | Yardley, PA 19067-5427 |
Second Address | Levittown, PA 19057-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1446589 | HIGHMARK BLUE SHIELD (01) | PA |