Active NPI
Alan L Crescuillo, DC
- Chiropractor
- Mount Vernon, OH
National Provider Identifier
1427176890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 792
- Practice address
- 210 East Chestnut Street
Mount Vernon, OH 43050 - Phone
- (740) 397-0003
- Fax
- (740) 397-4530
- NPI assigned
- Mar 26, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 792 | OH | Primary |
Addresses
Primary practice location
210 East Chestnut Street
Mount Vernon, OH 43050
Mailing address
210 East Chestnut Street
Mount Vernon, OH 43050
Phone (740) 397-0003
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0416795 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120209000383 | OH | Practitioner - Chiropractic | 7911164595 | Practice locations: Mount Vernon, OH |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 792 | OH | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1427176890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 EAST CHESTNUT STREET",
"city": "MOUNT VERNON",
"state": "OH",
"postal_code": "43050",
"telephone_number": "740-397-0003",
"fax_number": "740-397-4530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 EAST CHESTNUT STREET",
"city": "MOUNT VERNON",
"state": "OH",
"postal_code": "43050",
"telephone_number": "740-397-0003",
"fax_number": "740-397-4530"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRESCUILLO",
"first_name": "ALAN",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "OH",
"license": "792",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0416795",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.