Provider Demographics
NPI:1891896429
Name:CRADDUCK, HUGH M (DC)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:M
Last Name:CRADDUCK
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 1:5144 COLLEGE CORNER PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1068
Mailing Address - Country:US
Mailing Address - Phone:513-524-4800
Mailing Address - Fax:513-523-8631
Practice Address - Street 1:5144 COLLEGE CORNER PIKE STE A
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1068
Practice Address - Country:US
Practice Address - Phone:513-524-4800
Practice Address - Fax:513-523-8631
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000392716OtherANTHEM
OH2648531Medicaid
OH2648531Medicaid
OHCR4179681Medicare ID - Type Unspecified