Provider Demographics
NPI:1134381510
Name:ANDREW T. CRELLIN, D.C., R.P.T.
Entity type:Organization
Organization Name:ANDREW T. CRELLIN, D.C., R.P.T.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CRELLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, RPT
Authorized Official - Phone:401-821-6091
Mailing Address - Street 1:328 COWESETT AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-2248
Mailing Address - Country:US
Mailing Address - Phone:401-821-6091
Mailing Address - Fax:401-821-1880
Practice Address - Street 1:328 COWESETT AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-2248
Practice Address - Country:US
Practice Address - Phone:401-821-6091
Practice Address - Fax:401-821-1880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDREW T. CRELLIN, D.C., R.P.T.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRIDC301261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIT92415Medicare UPIN