Provider Demographics
NPI:1245366053
Name:CRANK, GARY MARK
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:MARK
Last Name:CRANK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 WEST ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-4406
Mailing Address - Country:US
Mailing Address - Phone:508-761-5333
Mailing Address - Fax:508-761-5333
Practice Address - Street 1:707 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-5932
Practice Address - Country:US
Practice Address - Phone:508-761-5333
Practice Address - Fax:508-761-5333
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1241111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4400799OtherUNITED HEALTHCARE
MA408786OtherB.C.B.S. RI
MAY36098OtherB.C.B.S. MA
MAY36098OtherB.C.B.S. MA
MAT38427Medicare UPIN