Provider Demographics
NPI:1982703401
Name:DAIGLE, CRAIG ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ROBERT
Last Name:DAIGLE
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 1:45 HILLSIDE STREET
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769
Mailing Address - Country:US
Mailing Address - Phone:207-768-5522
Mailing Address - Fax:207-764-1649
Practice Address - Street 1:45 HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2620
Practice Address - Country:US
Practice Address - Phone:207-768-5522
Practice Address - Fax:207-764-1649
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME026632OtherANTHEM STAR NUMBER
MEDAMM6635Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER