Provider Demographics
NPI:1679626493
Name:DONNA L CRAFT DC PC
Entity Type:Organization
Organization Name:DONNA L CRAFT DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-426-0902
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-0130
Mailing Address - Country:US
Mailing Address - Phone:734-426-0902
Mailing Address - Fax:734-426-0903
Practice Address - Street 1:8110 JACKSON RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9132
Practice Address - Country:US
Practice Address - Phone:734-426-0902
Practice Address - Fax:734-426-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0005006144OtherAETNA
MI0H11609OtherBCBS
MI950C850030OtherMI BCBS
MIP100937OtherBLUE CHOICE
MIT32925Medicare UPIN
MI0C85003Medicare ID - Type Unspecified