Provider Demographics
NPI:1205944469
Name:TANKERSLEY, CRAIG ELLIOTT (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ELLIOTT
Last Name:TANKERSLEY
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 1:2327 NW FEDERAL HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-9311
Mailing Address - Country:US
Mailing Address - Phone:615-420-0007
Mailing Address - Fax:
Practice Address - Street 1:2327 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-9311
Practice Address - Country:US
Practice Address - Phone:615-420-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4116123OtherBLUE CROSS BLUE SHIELD
TNU54097Medicare UPIN
TN4116123OtherBLUE CROSS BLUE SHIELD