DR. JACK D CROCKER (NPI# 1558321638) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558321638 |
| Entity Type | Individual |
| Full Name | DR. JACK D CROCKER |
| Credential | DC |
| Practice Address |
464 N Jefferson Ave Lebanon MO 65536-2742 |
| Practice Telephone | 4175329166 |
| Practice Fax Number | 4175329887 |
| Mailing Telephone | 4175329166 |
| Mailing Fax Number | 4175329887 |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2014-05-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 004819 | MO | Chiropractic Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144688490 | Jack Crocker | Dentist | 2441 Mineral Springs Rd, Lexington, SC 29072-9145 | 2016-02-02 |
| Street Address |
464 N JEFFERSON AVE |
| City | LEBANON |
| State | MO |
| Zip Code | 65536-2742 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760741813 | Shane R Ogle | Chiropractor | 464 N Jefferson Ave, Lebanon, MO 65536-2742 | 2012-05-10 |
| 1689957433 | Crocker Chiropractic, LLC | Chiropractor | 464 N Jefferson Ave, Lebanon, MO 65536-2742 | 2011-09-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427537307 | Cathy Jane Greenlee | Nurse Practitioner | 510 Hwy 32, Lebanon, MO 65536 | 2018-08-10 |
| 1396232831 | Steven Michael Majdecki | Counselor | 860 Lynn St., Lebanon, MO 65536 | 2018-04-19 |
| 1447629399 | Danielle Craig | Speech-Language Pathologist | 1200 Clark Ave, Lebanon, MO 65536 | 2015-09-22 |
| 1982080255 | Dawn Barker | Family Medicine | 331 Hospital Dr Ste C, Lebanon, MO 65536 | 2015-08-10 |
| 1194163840 | Laura Patton | Speech-Language Pathologist | 22864 Perimeter Drive, Lebanon, MO 65536 | 2013-06-04 |
| 1750588273 | Elaine Britzman | Registered Nurse | 874 S Jefferson St, Lebanon, MO 65536 | 2007-06-28 |
| 1538363486 | Laclede Co. Assoc. for Retarded Citizens | Respite Care | 200 Lawson Ave., Lebanon, MO 65536 | 2007-06-13 |
| 1568665768 | Fern M Klein | Registered Nurse | 874 S Jefferson, Lebanon, MO 65536 | 2007-06-06 |
| 1639201080 | Laclede County Assoc. for Retarded Citizens | Day Training, Developmentally Disabled Services | 200 Lawson Avenue, Lebanon, MO 65536 | 2007-03-12 |
| 1316078868 | Michael Montgomery Od PC | Optometrist | 279 E Elm, Lebanon, MO 65536 | 2007-03-08 |
| Find all providers in zip 65536 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396351698 | Comforting Hands Chiropractic LLC | Chiropractor | 1151 Cornwall Rd Ste 5, Lebanon, PA 17042-7233 | 2020-09-22 |
| 1821637026 | Molly Anna Pepin | Chiropractor | 103 Hanover St Ste 14, Lebanon, NH 03766-1098 | 2020-01-06 |
| 1508222068 | Margaret Swick | Chiropractor | 291 N Adams Ave, Lebanon, MO 65536-3045 | 2016-01-13 |
| 1750759684 | Crv Sport and Spine | Chiropractor | 103 Hanover St Ste 17, Lebanon, NH 03766-1098 | 2015-09-09 |
| 1700208212 | Lebanon Chiropractic Center | Chiropractor | 2234 Cumberland St, Lebanon, PA 17042-2583 | 2014-01-17 |
| 1356613384 | Center for Natural Health and Rehabilitation Inc | Chiropractor | 1386 Us Highway 22, Lebanon, NJ 08833-2205 | 2012-02-07 |
| 1497086953 | Tony Dejtiranukul | Chiropractor | 990 Belvedere Dr Ste B, Lebanon, OH 45036-1193 | 2010-01-23 |
| 1184855637 | Ronald Gary Clibborn | Chiropractor | 75 E Oak St, Lebanon, OR 97355-3223 | 2009-07-31 |
| 1912148982 | Susan K Kellogg | Chiropractor | 37 Bank St, Lebanon, NH 03766-1703 | 2009-03-20 |
| 1497902613 | Douglas Willen | Chiropractor | 1 Split Rail Ct, Lebanon, NJ 08833-3248 | 2008-08-19 |
| Find all providers in LEBANON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.