Provider Demographics
NPI:1255531760
Name:CRAIG, DANIEL (DOM,)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:CRAIG
Suffix:
Gender:M
Credentials:DOM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 LUISA ST STE 5A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4091
Mailing Address - Country:US
Mailing Address - Phone:505-660-6848
Mailing Address - Fax:505-989-1470
Practice Address - Street 1:1418 LUISA ST STE 5A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4091
Practice Address - Country:US
Practice Address - Phone:505-660-6848
Practice Address - Fax:505-989-1470
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM811171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist