Provider Demographics
NPI:1497263396
Name:CAMMANN, CRAIG A (LAC, DAC, DIPL AC,)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:A
Last Name:CAMMANN
Suffix:
Gender:M
Credentials:LAC, DAC, DIPL AC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 N MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1869
Mailing Address - Country:US
Mailing Address - Phone:802-560-8818
Mailing Address - Fax:
Practice Address - Street 1:11 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1869
Practice Address - Country:US
Practice Address - Phone:802-560-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-14
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006482171100000X
NY029697225700000X
VT91.0134044171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006482OtherACUPUNCTURE LICENSE
NY029697OtherMASSAGE THERAPY LICENSE
VT0910134044OtherACUPUNCTURE LICENSE
14483909OtherCAQH