Provider Demographics
NPI:1982806808
Name:CRAIG, CHAD OWEN (DC)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:OWEN
Last Name:CRAIG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7107 SOUTH YALE AVE #252
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136
Mailing Address - Country:US
Mailing Address - Phone:918-477-9117
Mailing Address - Fax:918-610-5325
Practice Address - Street 1:5065 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7010
Practice Address - Country:US
Practice Address - Phone:918-610-5200
Practice Address - Fax:918-610-5325
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKV68323Medicare UPIN