Provider Demographics
NPI:1396818399
Name:COLDITZ, CRAIG W (DC)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:W
Last Name:COLDITZ
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 1:42 EAST MAIDEN STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301
Mailing Address - Country:US
Mailing Address - Phone:724-225-2225
Mailing Address - Fax:724-225-5746
Practice Address - Street 1:42 EAST MAIDEN STREET
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-225-2225
Practice Address - Fax:724-225-5746
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 007194 L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU07225OtherBCBS
PAU07225OtherBCBS
PA007344K76Medicare ID - Type Unspecified