Provider Demographics
NPI:1518994904
Name:CRADIC, DONALD R (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:CRADIC
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 1:3850 W 16TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4108
Mailing Address - Country:US
Mailing Address - Phone:928-344-2460
Mailing Address - Fax:928-782-7262
Practice Address - Street 1:3850 W 16TH ST STE C
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4108
Practice Address - Country:US
Practice Address - Phone:928-344-2460
Practice Address - Fax:928-782-7262
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5037111N00000X
CA21930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor