Healthcare Provider Details

I. General information

NPI: 1104845122
Provider Name (Legal Business Name): CRAIG L. DILLMAN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 JUTLAND DR STE 202
SAN DIEGO CA
92117-3661
US

IV. Provider business mailing address

4241 JUTLAND DR STE 202
SAN DIEGO CA
92117-3661
US

V. Phone/Fax

Practice location:
  • Phone: 619-275-0922
  • Fax: 619-275-0945
Mailing address:
  • Phone: 619-275-0922
  • Fax: 619-275-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC14004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: