Provider Demographics
NPI:1912938804
Name:CRAIG, SUSAN E (DC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:CRAIG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45941 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-6217
Mailing Address - Country:US
Mailing Address - Phone:586-884-4825
Mailing Address - Fax:586-488-1084
Practice Address - Street 1:45941 HAYES RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-6217
Practice Address - Country:US
Practice Address - Phone:586-884-4825
Practice Address - Fax:586-488-1084
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E03439OtherBCBSM
MIMI4616001Medicare PIN
MIM09520007Medicare PIN
MIU89519Medicare UPIN