Provider Demographics
NPI:1639176209
Name:CRAVEN, MICHAEL A (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:CRAVEN
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 1:5420 LAND O LAKES BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-3401
Mailing Address - Country:US
Mailing Address - Phone:813-996-9800
Mailing Address - Fax:813-996-3326
Practice Address - Street 1:5420 LAND O LAKES BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-3401
Practice Address - Country:US
Practice Address - Phone:813-996-9800
Practice Address - Fax:813-996-3326
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2008-10-11
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
FLCH2874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor