Provider Demographics
NPI:1497754535
Name:PETEK, CRAIG K (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:K
Last Name:PETEK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CRAIG
Other - Middle Name:KEVIN
Other - Last Name:PETEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:6470 SPALDING DR
Mailing Address - Street 2:STE. J
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1807
Mailing Address - Country:US
Mailing Address - Phone:770-447-5116
Mailing Address - Fax:770-447-0900
Practice Address - Street 1:6470 SPALDING DR
Practice Address - Street 2:STE. J
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1807
Practice Address - Country:US
Practice Address - Phone:770-447-5116
Practice Address - Fax:770-447-0900
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAT97779Medicare UPIN