Provider Demographics
NPI:1912083916
Name:BLACK, CRAIG MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MARTIN
Last Name:BLACK
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 1:1255 HWY 395 N
Mailing Address - Street 2:SUITE B
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410
Mailing Address - Country:US
Mailing Address - Phone:775-783-3494
Mailing Address - Fax:
Practice Address - Street 1:1255 HWY 395 N
Practice Address - Street 2:SUITE B
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410
Practice Address - Country:US
Practice Address - Phone:775-783-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor