Provider Demographics
NPI:1376599332
Name:BARTELT, CRAIG ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALAN
Last Name:BARTELT
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 1:2902 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7102
Mailing Address - Country:US
Mailing Address - Phone:270-769-2255
Mailing Address - Fax:270-763-9773
Practice Address - Street 1:2902 DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7102
Practice Address - Country:US
Practice Address - Phone:270-769-2255
Practice Address - Fax:270-763-9773
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000295204OtherANTHEM BCBS PROVIDER #
20-0070241OtherFEDERAL TAX I.D.#
KY50001789OtherPASSPORT PROVIDER I.D.#
KY85002889Medicaid
KY000000295204OtherANTHEM BCBS PROVIDER #
KY6780401Medicare ID - Type UnspecifiedPROVIDER I.D. #