Provider Demographics
NPI:1861697435
Name:CROWE, KEITH HUGH (BS, DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:HUGH
Last Name:CROWE
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7255
Mailing Address - Country:US
Mailing Address - Phone:770-507-5226
Mailing Address - Fax:770-507-5767
Practice Address - Street 1:505 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7255
Practice Address - Country:US
Practice Address - Phone:770-507-5226
Practice Address - Fax:770-507-5767
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO06406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU77343Medicare UPIN
GA35ZCFSFMedicare ID - Type UnspecifiedMEDICARE IDENTIFICATION