1700849379 NPI number — CRAFT CHIROPRACTIC CENTER PC

Table of content: AUNG M OO RDH (NPI 1407339609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700849379 NPI number — CRAFT CHIROPRACTIC CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRAFT CHIROPRACTIC CENTER PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700849379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48813-0236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-543-1115
Provider Business Mailing Address Fax Number:
517-543-3290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 LANSING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48813-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-543-1115
Provider Business Practice Location Address Fax Number:
517-543-3290
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRAFT
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
517-543-1115

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0B31023 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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