Provider Demographics
NPI:1407987530
Name:SMITH, CRAIG WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:WILLIAM
Last Name:SMITH
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 1:925 S CHURCH ST
Mailing Address - Street 2:STE A200
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-4997
Mailing Address - Country:US
Mailing Address - Phone:615-867-1144
Mailing Address - Fax:615-814-2159
Practice Address - Street 1:4426 W WALTON BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4073
Practice Address - Country:US
Practice Address - Phone:248-674-4711
Practice Address - Fax:248-674-4712
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3439111N00000X
MI2301007755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4292119Medicaid
MION 20460Medicare ID - Type UnspecifiedMEDICARE
MD4292119Medicaid