Provider Demographics
NPI:1841392735
Name:GRUBER, CRAIG DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:DANIEL
Last Name:GRUBER
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 1:3940 CHEROKEE ST NW
Mailing Address - Street 2:SUITE 402
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6421
Mailing Address - Country:US
Mailing Address - Phone:770-423-9010
Mailing Address - Fax:
Practice Address - Street 1:3940 CHEROKEE ST NW
Practice Address - Street 2:SUITE 402
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6421
Practice Address - Country:US
Practice Address - Phone:770-423-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGCSMedicare ID - Type UnspecifiedMEDICARE ID NO
GAU42606Medicare UPIN