Individual provider Active NPI

Paul Henry Cronk, DC

  • Chiropractor
  • Roanoke, VA
National Provider Identifier
1114016904
Registry record updated Sep 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0104000165 Issued in VA
Practice address
217 Albemarle Avenue SW
Roanoke, VA 24016-4716
Phone
(540) 344-6738
Fax
(540) 344-8047
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 0104000165 VA Primary

Addresses

Primary practice location

217 Albemarle Avenue SW
Roanoke, VA 24016-4716

Mailing address

217 Albemarle Avenue SW
Roanoke, VA 24016-4716
Phone (540) 344-6738

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061201000029 VA Practitioner - Chiropractic 1557369485 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

217 Albemarle Ave SW
Roanoke, VA 24016-4716
Phone (540) 344-6738

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0104000165VAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Stoke Chiropractic Clinic Inc Chiropractor CurrentSince Jun 13, 2010 Accepting new patients

Locations

217 Albemarle Ave SW
Roanoke, VA 24016
Phone (540) 342-4010

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283472000000",
    "number": "1114016904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 ALBEMARLE AVENUE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164716",
            "telephone_number": "540-344-6738",
            "fax_number": "540-344-8047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 ALBEMARLE AVENUE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240164716",
            "telephone_number": "540-344-6738",
            "fax_number": "540-344-8047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRONK",
        "first_name": "PAUL",
        "middle_name": "HENRY",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2010-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104000165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.