Provider Demographics
NPI:1952409310
Name:JEFFREY T CRAIG, DC, PC
Entity type:Organization
Organization Name:JEFFREY T CRAIG, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-330-6581
Mailing Address - Street 1:875 SE 3RD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1786
Mailing Address - Country:US
Mailing Address - Phone:541-330-6581
Mailing Address - Fax:541-330-2326
Practice Address - Street 1:875 SE 3RD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1786
Practice Address - Country:US
Practice Address - Phone:541-330-6581
Practice Address - Fax:541-330-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU81747Medicare UPIN
OR118472Medicare ID - Type Unspecified
OR118470Medicare ID - Type Unspecified