Provider Demographics
NPI:1023401908
Name:CRAIG, SAMANTHA LEE (DC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LEE
Other - Last Name:BURROWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3917 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3047
Mailing Address - Country:US
Mailing Address - Phone:479-648-1722
Mailing Address - Fax:479-783-6325
Practice Address - Street 1:3917 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3047
Practice Address - Country:US
Practice Address - Phone:479-648-1722
Practice Address - Fax:479-783-6325
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor