Provider Demographics
NPI:1164577607
Name:CRAFT CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:CRAFT CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-781-7549
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-0735
Mailing Address - Country:US
Mailing Address - Phone:269-781-7549
Mailing Address - Fax:269-781-4579
Practice Address - Street 1:125 REDFIELD PLZ
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1466
Practice Address - Country:US
Practice Address - Phone:269-781-7549
Practice Address - Fax:269-781-4579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950A311360OtherBCBSMI
MI0N33190Medicare ID - Type Unspecified
MIX62252Medicare UPIN