Provider Demographics
NPI:1205043601
Name:CRAIG CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:CRAIG CHIROPRACTIC CLINIC, P.C.
Other - Org Name:THRIVE CHIROPRACTIC & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GENTILINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-659-4220
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-0190
Mailing Address - Country:US
Mailing Address - Phone:303-659-4220
Mailing Address - Fax:303-659-1832
Practice Address - Street 1:429 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2101
Practice Address - Country:US
Practice Address - Phone:303-659-4220
Practice Address - Fax:303-659-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCR637338OtherBCBS GROUP #
COC389208Medicare ID - Type UnspecifiedMEDICARE GROUP #
COC389208Medicare PIN