Provider Demographics
NPI:1598861429
Name:EVERINGHAM, CRAIG JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:JAMES
Last Name:EVERINGHAM
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 1:36738 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-1278
Mailing Address - Country:US
Mailing Address - Phone:734-941-5620
Mailing Address - Fax:734-941-5625
Practice Address - Street 1:36738 GODDARD RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174
Practice Address - Country:US
Practice Address - Phone:734-941-5620
Practice Address - Fax:734-941-5625
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU94928Medicare UPIN
MI0N76120Medicare ID - Type Unspecified