Provider Demographics
NPI:1659406759
Name:COHEN, CRAIG STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:STEVEN
Last Name:COHEN
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:PO BOX 30819
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588
Mailing Address - Country:US
Mailing Address - Phone:843-652-5678
Mailing Address - Fax:843-357-1471
Practice Address - Street 1:804 INLET SQUARE DRIVE
Practice Address - Street 2:UNIT B
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-652-5678
Practice Address - Fax:843-357-1471
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3339111N00000X
SC20414363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC9599G447OtherMEDICARE
SCAA8480G447OtherMEDICARE