Provider Demographics
NPI:1508809443
Name:DUNN, CRAIG (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:DUNN
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 1:7400 UNION PARK AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-6707
Mailing Address - Country:US
Mailing Address - Phone:801-568-1598
Mailing Address - Fax:801-568-1594
Practice Address - Street 1:7400 UNION PARK AVE STE 302
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-6707
Practice Address - Country:US
Practice Address - Phone:801-568-1598
Practice Address - Fax:801-568-1594
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT175562-1202111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU33361Medicare UPIN