Individual
JACOB CROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1001 E 17TH ST, BLOOMINGTON, IN 47408-1590
(812) 855-3618
Mailing address
205 E 6TH ST, BLOOMINGTON, IN 47408-3517
(812) 855-3618
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002259A
IN
Other
Enumeration date
12/02/2014
Last updated
12/02/2014
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