Provider Demographics
NPI:1376704981
Name:FOREMAN, CRAIG WILLIAM
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:WILLIAM
Last Name:FOREMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CRAIG
Other - Middle Name:WILLIAM
Other - Last Name:FOREMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DL
Mailing Address - Street 1:4616 W SAHARA AVE # 337
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-3654
Mailing Address - Country:US
Mailing Address - Phone:702-227-4040
Mailing Address - Fax:702-227-4724
Practice Address - Street 1:3835 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-7125
Practice Address - Country:US
Practice Address - Phone:702-251-8293
Practice Address - Fax:702-251-8297
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor