Provider Demographics
NPI:1013421916
Name:CRAIG, CHARLES PATRICK (DC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:PATRICK
Last Name:CRAIG
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 1:1514 10TH AVE N APT A
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1114
Mailing Address - Country:US
Mailing Address - Phone:570-401-0884
Mailing Address - Fax:
Practice Address - Street 1:2017 DREW ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3116
Practice Address - Country:US
Practice Address - Phone:727-797-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor