Provider Demographics
NPI:1598187122
Name:CRAIG S HENZLER DC PC
Entity Type:Organization
Organization Name:CRAIG S HENZLER DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:HENZLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-373-5040
Mailing Address - Street 1:906 LAFAYETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5617
Mailing Address - Country:US
Mailing Address - Phone:540-373-5040
Mailing Address - Fax:540-373-0423
Practice Address - Street 1:906 LAFAYETTE BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5617
Practice Address - Country:US
Practice Address - Phone:540-373-5040
Practice Address - Fax:540-373-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104555857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA67327Medicare UPIN