Provider Demographics
NPI:1750454211
Name:CAVINESS, CRAIG T (DC, CNIM)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:T
Last Name:CAVINESS
Suffix:
Gender:M
Credentials:DC, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 TEANECK RD
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4854
Mailing Address - Country:US
Mailing Address - Phone:201-862-9900
Mailing Address - Fax:201-862-9136
Practice Address - Street 1:1086 TEANECK RD
Practice Address - Street 2:SUITE 4A
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4854
Practice Address - Country:US
Practice Address - Phone:201-862-9900
Practice Address - Fax:201-862-9136
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010557111N00000X
1129246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No111N00000XChiropractic ProvidersChiropractor