Provider Demographics
NPI:1013011188
Name:CRAINE, JAMES GREGORY (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GREGORY
Last Name:CRAINE
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 1:3 LIFEMARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960
Mailing Address - Country:US
Mailing Address - Phone:215-258-0155
Mailing Address - Fax:215-258-0112
Practice Address - Street 1:124 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454
Practice Address - Country:US
Practice Address - Phone:215-258-0155
Practice Address - Fax:215-258-0112
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005595L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01755389Medicaid
U71782Medicare UPIN
PA015323Medicare PIN