Provider Demographics
NPI:1245385756
Name:CRAFTED CARE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:CRAFTED CARE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LEINDECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-627-9111
Mailing Address - Street 1:900 E SAGINAW HWY
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-9419
Mailing Address - Country:US
Mailing Address - Phone:517-627-9111
Mailing Address - Fax:517-627-1023
Practice Address - Street 1:900 E SAGINAW HWY
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-9419
Practice Address - Country:US
Practice Address - Phone:517-627-9111
Practice Address - Fax:517-627-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B310220OtherBCBSMI
MI950B310220OtherBCBSMI
MI0N33190Medicare ID - Type Unspecified