Provider Demographics
NPI:1821218108
Name:ANDERSON, CRAIG WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WILLIAM
Last Name:ANDERSON
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:PO BOX 908
Mailing Address - Street 2:36 W. MAIN ST
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025-0908
Mailing Address - Country:US
Mailing Address - Phone:518-883-3877
Mailing Address - Fax:518-883-8178
Practice Address - Street 1:36 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:BROADALBIN
Practice Address - State:NY
Practice Address - Zip Code:12025-0908
Practice Address - Country:US
Practice Address - Phone:518-883-3877
Practice Address - Fax:518-883-8178
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007617111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX66372OtherBC
NY10038278OtherCDPHP
NY930862OtherMPN
NY98L152OtherMVP
NY10038278OtherCDPHP
NYRA8039Medicare UPIN