Individual
DR. LANNY CRAIG CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1300 S MAIN ST, STE A, SNOWFLAKE, AZ 85937-5662
(928) 536-5525
(928) 484-6070
Mailing address
1300 S MAIN ST, STE A, SNOWFLAKE, AZ 85937-5662
(928) 536-5525
(928) 484-6070
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
7414
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
841595
—
AZ
01
—
AZ0939810
BLUE CROSS BLUE SHIELD AZ
AZ
Enumeration date
03/28/2006
Last updated
02/23/2017
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