Provider Demographics
NPI:1700849379
Name:CRAFT CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:CRAFT CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-543-1115
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-0236
Mailing Address - Country:US
Mailing Address - Phone:517-543-1115
Mailing Address - Fax:517-543-3290
Practice Address - Street 1:223 LANSING ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1605
Practice Address - Country:US
Practice Address - Phone:517-543-1115
Practice Address - Fax:517-543-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B31023OtherBCBS OF MICHIGAN
MI0B31023OtherBCBS OF MICHIGAN