Provider Demographics
NPI:1124012612
Name:CASTANET, CRAIG JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:JOHN
Last Name:CASTANET
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 1:2771 LAWRENCEVILLE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2500
Mailing Address - Country:US
Mailing Address - Phone:404-558-4015
Mailing Address - Fax:770-908-0463
Practice Address - Street 1:2771 LAWRENCEVILLE HWY STE 101
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2500
Practice Address - Country:US
Practice Address - Phone:404-558-4015
Practice Address - Fax:770-908-0463
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-10
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002767111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV09257Medicare UPIN