Provider Demographics
NPI:1538217062
Name:CRUICKSHANK, CHARLES DAVID SR (DC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DAVID
Last Name:CRUICKSHANK
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 RACE ROAD
Mailing Address - Street 2:STE A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237
Mailing Address - Country:US
Mailing Address - Phone:410-687-3313
Mailing Address - Fax:410-687-7667
Practice Address - Street 1:1226 RACE ROAD
Practice Address - Street 2:STE A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-687-3313
Practice Address - Fax:410-687-7667
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM563OtherCAREFIRST BLUE CROSS BS
MDW3720001OtherGHMSI
MDM563OtherCAREFIRST BLUE CROSS BS