Provider Demographics
NPI:1598938003
Name:CRAIG J. DYKGRAAF D.C., P.C.
Entity Type:Organization
Organization Name:CRAIG J. DYKGRAAF D.C., P.C.
Other - Org Name:PLAINFIELD CHIROPRACTIC OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DYKGRAAF
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:616-363-7771
Mailing Address - Street 1:1715 4 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2440
Mailing Address - Country:US
Mailing Address - Phone:616-363-7771
Mailing Address - Fax:616-363-5794
Practice Address - Street 1:1715 4 MILE RD NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-2440
Practice Address - Country:US
Practice Address - Phone:616-363-7771
Practice Address - Fax:616-363-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICD002275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350046640OtherRR MEDICARE
MI950D150730OtherBCBS
MICD002275OtherBCN
MIT33008Medicare UPIN
MI350046640OtherRR MEDICARE