Provider Demographics
NPI:1376659862
Name:SHAEFFER, CRAIG JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:JOSEPH
Last Name:SHAEFFER
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 1:4110 17 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6880
Mailing Address - Country:US
Mailing Address - Phone:586-978-0170
Mailing Address - Fax:586-978-1304
Practice Address - Street 1:4110 17 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6880
Practice Address - Country:US
Practice Address - Phone:586-978-0170
Practice Address - Fax:586-978-1304
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1780111Medicaid
MIT33140Medicare UPIN
MI0E05066Medicare ID - Type Unspecified