Provider Demographics
NPI:1780684233
Name:TIBURZI, CRAIG ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ANDREW
Last Name:TIBURZI
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 1:110 E 1ST NORTH ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1505
Mailing Address - Country:US
Mailing Address - Phone:217-854-8001
Mailing Address - Fax:217-854-3440
Practice Address - Street 1:130 CARLINVILLE PLZ
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1191
Practice Address - Country:US
Practice Address - Phone:217-854-8001
Practice Address - Fax:217-854-3440
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5932018OtherBLUE CROSS BLUE SHIELD ID
ILP00184408OtherRAILROAD MEDICARE ID
IL632998OtherHEALTHLINK PPO ID
IL5932018OtherBLUE CROSS BLUE SHIELD ID
IL210480Medicare ID - Type Unspecified