Provider Demographics
NPI:1114041431
Name:MORTENSEN, CRAIG CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:CHRISTOPHER
Last Name:MORTENSEN
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 1:151 N KRAEMER BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5050
Mailing Address - Country:US
Mailing Address - Phone:714-996-1444
Mailing Address - Fax:
Practice Address - Street 1:151 N KRAEMER BLVD STE 115
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5050
Practice Address - Country:US
Practice Address - Phone:714-996-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor