Provider Demographics
NPI:1255482345
Name:KINGSBURY, CRAIG ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALAN
Last Name:KINGSBURY
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 1:115 CLOVER ST
Mailing Address - Street 2:#100
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3266
Mailing Address - Country:US
Mailing Address - Phone:616-392-2166
Mailing Address - Fax:
Practice Address - Street 1:115 CLOVER ST
Practice Address - Street 2:#100
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3266
Practice Address - Country:US
Practice Address - Phone:616-392-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008835111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION99020Medicare ID - Type Unspecified