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DR. LANNY CRAIG CROCKETT DC

>> Chiropractor >> Chiropractic Providers

Registrant NPI Number: 1780644195

Individual Registrant:
DR. LANNY CRAIG CROCKETT DC
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1300 S MAIN ST STE A SNOWFLAKE, AZ 85937-5662 US
Tel: 928-536-5525  Fax: 928-484-6070

Contact information for business:
1300 S MAIN ST STE A SNOWFLAKE, AZ 85937-5662 US
Tel: 928-536-5525  Fax: 928-484-6070

Registration Information:
NPI: 1780644195
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y111N00000XChiropractic Providers
Chiropractor
AZ7414

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
841595AZ05
BLUE CROSS BLUE SHIELD AZAZ0939810AZ01




HEALTH CARE JOBS AZ - Page 1



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