Provider Demographics
NPI:1861491003
Name:SHAPIRO, CRAIG BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:BRIAN
Last Name:SHAPIRO
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 1:714 REED ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-5739
Mailing Address - Country:US
Mailing Address - Phone:215-627-1610
Mailing Address - Fax:215-334-7726
Practice Address - Street 1:714 REED ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-5739
Practice Address - Country:US
Practice Address - Phone:215-627-1610
Practice Address - Fax:267-514-2990
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007201-L111N00000X
NJ38MC00616800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0258822000OtherKEYSTONE
PA099574OtherBLUE SHEILD
PA099574OtherBLUE SHEILD
U77093Medicare UPIN