1386712263 NPI number — DR. JOSEPH MARK CRUM DC, CCRD, CCSP

Table of content: DR. JOSEPH MARK CRUM DC, CCRD, CCSP (NPI 1386712263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386712263 NPI number — DR. JOSEPH MARK CRUM DC, CCRD, CCSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUM
Provider First Name:
JOSEPH
Provider Middle Name:
MARK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC, CCRD, CCSP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386712263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
359 COMMONWEALTH AVE STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24201-3868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-669-0969
Provider Business Mailing Address Fax Number:
276-669-0969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
359 COMMONWEALTH AVE STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24201-3868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-669-0969
Provider Business Practice Location Address Fax Number:
276-669-0969
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  0104001471 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5697482 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 241832 . This is a "BCBS OF VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3040218 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 541836647 . This is a "TAX ID#" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2116065 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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