Provider Demographics
NPI:1003324435
Name:ULLMAN, CRAIG (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:ULLMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 16TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-3134
Mailing Address - Country:US
Mailing Address - Phone:406-590-5900
Mailing Address - Fax:406-453-5197
Practice Address - Street 1:1400 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-3134
Practice Address - Country:US
Practice Address - Phone:406-590-5900
Practice Address - Fax:406-453-5197
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1073791547Medicaid