Provider Demographics
NPI:1336145242
Name:SHARP, CRAIG LEE III (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:LEE
Last Name:SHARP
Suffix:III
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 1:1800 TULLY RD
Mailing Address - Street 2:STE D
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-2923
Mailing Address - Country:US
Mailing Address - Phone:209-577-4767
Mailing Address - Fax:209-577-4815
Practice Address - Street 1:1800 TULLY RD
Practice Address - Street 2:STE D
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2923
Practice Address - Country:US
Practice Address - Phone:209-577-4767
Practice Address - Fax:209-577-4815
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor