Provider Demographics
NPI:1891758959
Name:GAGNON, CRAIG A (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:GAGNON
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 1:805 E GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-4271
Mailing Address - Country:US
Mailing Address - Phone:864-366-2024
Mailing Address - Fax:864-366-2024
Practice Address - Street 1:805 E GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-4271
Practice Address - Country:US
Practice Address - Phone:864-366-2024
Practice Address - Fax:864-366-2024
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1002Medicaid
SCCH1002Medicaid