Provider Demographics
NPI:1417170986
Name:DAVID A. CRAIG, DC, PA
Entity Type:Organization
Organization Name:DAVID A. CRAIG, DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PA
Authorized Official - Phone:407-359-7246
Mailing Address - Street 1:2200 WINTER SPRINGS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9358
Mailing Address - Country:US
Mailing Address - Phone:407-359-7246
Mailing Address - Fax:407-359-2225
Practice Address - Street 1:2200 WINTER SPRINGS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9358
Practice Address - Country:US
Practice Address - Phone:407-359-7246
Practice Address - Fax:407-359-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH00007410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55634Medicare ID - Type Unspecified
FLU67893Medicare UPIN