Provider Demographics
NPI:1841479151
Name:STASIO, CRAIG ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALLEN
Last Name:STASIO
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 1:40410 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-2542
Mailing Address - Country:US
Mailing Address - Phone:586-464-0053
Mailing Address - Fax:586-464-0063
Practice Address - Street 1:40410 HAYES RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-2542
Practice Address - Country:US
Practice Address - Phone:586-464-0053
Practice Address - Fax:586-464-0063
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007308111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM29960001Medicare PIN