Provider Demographics
NPI:1750389896
Name:DENHOLM, CRAIG BRUCE (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:BRUCE
Last Name:DENHOLM
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 1:6838 M 93 HWY S
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-7766
Mailing Address - Country:US
Mailing Address - Phone:989-348-6600
Mailing Address - Fax:989-348-3537
Practice Address - Street 1:6838 M 93 HWY S
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-7766
Practice Address - Country:US
Practice Address - Phone:989-348-6600
Practice Address - Fax:989-348-3537
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4178606Medicaid
MIU23010Medicare UPIN
MI4178606Medicaid