Provider Demographics
NPI:1104845122
Name:DILLMAN, CRAIG L (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:L
Last Name:DILLMAN
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 1:4241 JUTLAND DR
Mailing Address - Street 2:STE 202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3661
Mailing Address - Country:US
Mailing Address - Phone:619-275-0922
Mailing Address - Fax:619-275-0945
Practice Address - Street 1:4241 JUTLAND DR
Practice Address - Street 2:STE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3661
Practice Address - Country:US
Practice Address - Phone:619-275-0922
Practice Address - Fax:619-275-0945
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14004111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC14004Medicare ID - Type Unspecified
CAT17669Medicare UPIN