Provider Demographics
NPI:1851574651
Name:PFEFFER CH, CRAIG W (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:W
Last Name:PFEFFER CH
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 1:10131 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3649
Mailing Address - Country:US
Mailing Address - Phone:502-267-6444
Mailing Address - Fax:502-267-6445
Practice Address - Street 1:10131 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONTOWN
Practice Address - State:KY
Practice Address - Zip Code:40299-3649
Practice Address - Country:US
Practice Address - Phone:502-267-6444
Practice Address - Fax:502-267-6445
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1116809OtherPASSPORT
KY85036549Medicaid
KY000000069294OtherANTHEM
KY1116809OtherPASSPORT