Provider Demographics
NPI:1346495256
Name:AMRINE, CRAIG STEPHEN (LAC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:STEPHEN
Last Name:AMRINE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 E UNIVERSITY DR
Mailing Address - Street 2:UNIT 152
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-4671
Mailing Address - Country:US
Mailing Address - Phone:602-430-5812
Mailing Address - Fax:
Practice Address - Street 1:1250 E BASELINE RD
Practice Address - Street 2:SUITE 104-B
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1436
Practice Address - Country:US
Practice Address - Phone:602-430-5812
Practice Address - Fax:480-456-0409
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0604171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist