Provider Demographics
NPI:1952490203
Name:HENZLER, CRAIG STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:STEPHEN
Last Name:HENZLER
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 1:906 LAFAYETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5617
Mailing Address - Country:US
Mailing Address - Phone:540-373-5040
Mailing Address - Fax:540-373-0423
Practice Address - Street 1:906 LAFAYETTE BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5617
Practice Address - Country:US
Practice Address - Phone:540-373-5040
Practice Address - Fax:540-373-0423
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
67327Medicare UPIN
VA350001125Medicare ID - Type Unspecified