Provider Demographics
NPI:1740230218
Name:BLAGOUE, CRAIG ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ANTHONY
Last Name:BLAGOUE
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 1:87 HAMMOND LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2000
Mailing Address - Country:US
Mailing Address - Phone:518-324-6090
Mailing Address - Fax:518-324-6091
Practice Address - Street 1:87 HAMMOND LN
Practice Address - Street 2:SUITE A
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2000
Practice Address - Country:US
Practice Address - Phone:518-324-6090
Practice Address - Fax:518-324-6091
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011137-1111N00000X
IL038-010189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA8869Medicare PIN
NYV02552Medicare UPIN