Provider Demographics
NPI:1356474282
Name:WEHRENBERG, CRAIG ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ROBERT
Last Name:WEHRENBERG
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 1:1 FAIRCHILD SQ
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1261
Mailing Address - Country:US
Mailing Address - Phone:518-877-7112
Mailing Address - Fax:518-877-7114
Practice Address - Street 1:1 FAIRCHILD SQ
Practice Address - Street 2:SUITE 6
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1261
Practice Address - Country:US
Practice Address - Phone:518-877-7112
Practice Address - Fax:518-877-7114
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53275CMedicare ID - Type Unspecified
NYU28462Medicare UPIN