Provider Demographics
NPI:1245281609
Name:HAZLEWOOD, CRAIG ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALAN
Last Name:HAZLEWOOD
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 1:622 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-1605
Mailing Address - Country:US
Mailing Address - Phone:803-818-5522
Mailing Address - Fax:803-818-5523
Practice Address - Street 1:622 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1605
Practice Address - Country:US
Practice Address - Phone:803-818-5522
Practice Address - Fax:803-818-5523
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U902840281Medicare UPIN