Provider Demographics
NPI:1902268956
Name:CRUTCHFIELD, JOHN R (BOCO, BOCP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:CRUTCHFIELD
Suffix:
Gender:M
Credentials:BOCO, BOCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-4309
Mailing Address - Country:US
Mailing Address - Phone:336-333-9081
Mailing Address - Fax:
Practice Address - Street 1:2301 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-4309
Practice Address - Country:US
Practice Address - Phone:336-333-9081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist