Provider Demographics
NPI:1912037656
Name:STORCK, CRAIG WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WAYNE
Last Name:STORCK
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 1:11815 CAENEN ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210
Mailing Address - Country:US
Mailing Address - Phone:913-980-9552
Mailing Address - Fax:
Practice Address - Street 1:11815 CAENEN ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2733
Practice Address - Country:US
Practice Address - Phone:913-980-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04208111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician