Edwin Ernest Croucher III, D.C.
Individual provider Active NPI Chiropractor · Baldwinsville, NY
NPI 1194250787 · NPPES record last updated Apr 21, 2017
Key facts
- NPI
- 1194250787
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 012945 (NY)
- Practice address
- 136 E Genesee St
Baldwinsville, NY 13027-2720 - Phone
- (315) 635-2333
- NPI assigned
- Apr 21, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Life Chiropractic College, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Upstate Chiropractic, PC
Practice addresses (Care Compare)
136 E Genesee St
Baldwinsville, NY 13027-2720
Phone (315) 635-2333
138 E Genesee St
Baldwinsville, NY 13027-2720
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170508000896 | NY | Practitioner - Chiropractic | 0143507871 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012945 | NY | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upstate Chiropractic, PC | Current |
Accepting new patients |
Locations
136 E Genesee St
Baldwinsville, NY 13027
Phone (315) 635-2333
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 012945 | NY | Yes |
Addresses
Primary practice location
136 E Genesee St
Baldwinsville, NY 13027-2720
Mailing address
136 E Genesee St
Baldwinsville, NY 13027-2720
Phone (315) 635-2333
Other providers in Baldwinsville, NY
- Jacquelyn S Coreia
- Lisa Marie Cornell
- Chelsea Coulter
- Andrea Louise Cox
- Crista Zirgulis
- Eric Edward Croucher
- Rebecca Lynn Croucher
- Christina Crutchfield
- Skylar R Crysler
- Marlena Cunningham
All providers in Baldwinsville, NY · Chiropractor in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.