Provider Demographics
NPI:1376765255
Name:JOHN, CRAIG P (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:P
Last Name:JOHN
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 1:44035 RIVERSIDE PKWY
Mailing Address - Street 2:345
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8260
Mailing Address - Country:US
Mailing Address - Phone:717-919-1108
Mailing Address - Fax:
Practice Address - Street 1:44035 RIVERSIDE PKWY
Practice Address - Street 2:345
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8260
Practice Address - Country:US
Practice Address - Phone:717-919-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009794111N00000X
VA0104556539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor