Provider Demographics
NPI:1720232564
Name:CRAIG L. DILLMAN, A CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:CRAIG L. DILLMAN, A CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:L
Authorized Official - Last Name:DILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-275-0922
Mailing Address - Street 1:4295 GESNER ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6649
Mailing Address - Country:US
Mailing Address - Phone:619-275-0922
Mailing Address - Fax:
Practice Address - Street 1:4295 GESNER ST STE 3A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6649
Practice Address - Country:US
Practice Address - Phone:619-275-0922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14004111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC14004Medicare PIN