Provider Demographics
NPI:1629178496
Name:CRAIG, DAVID IRA JR (NMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IRA
Last Name:CRAIG
Suffix:JR
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3918
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85902-3918
Mailing Address - Country:US
Mailing Address - Phone:928-240-0776
Mailing Address - Fax:
Practice Address - Street 1:1201 WEST SIERRA PINES DRIVE
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901
Practice Address - Country:US
Practice Address - Phone:928-240-0776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04-818175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath