Jimmy Lee McCrackin, D.C.
Individual provider Active NPI Chiropractor · Las Animas, CO
NPI 1700224748 · NPPES record last updated Jun 12, 2013
Key facts
- NPI
- 1700224748
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 6857 (CO)
- Practice address
- 304 Carson Ave
Las Animas, CO 81054-1144 - Phone
- (719) 456-0385
- NPI assigned
- Jun 12, 2013
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6857 | CO | MD | Pediatric Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 6857 | CO | Yes |
Addresses
Primary practice location
304 Carson Ave
Las Animas, CO 81054-1144
Mailing address
304 Carson Ave
Las Animas, CO 81054-1144
Phone (719) 456-0385
Other providers in Las Animas, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.