Provider Demographics
NPI:1518986041
Name:CRAIG, JEFFREY THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:CRAIG
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 1:875 SE 3RD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1786
Mailing Address - Country:US
Mailing Address - Phone:541-330-8313
Mailing Address - Fax:541-330-2326
Practice Address - Street 1:875 SE 3RD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1786
Practice Address - Country:US
Practice Address - Phone:541-330-8313
Practice Address - Fax:541-330-2326
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR118470Medicare ID - Type UnspecifiedGROUP#
OR118472Medicare PIN
ORU81747Medicare UPIN