Healthcare Provider Details

I. General information

NPI: 1720232564
Provider Name (Legal Business Name): CRAIG L. DILLMAN, A CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4295 GESNER ST STE 3A
SAN DIEGO CA
92117-6649
US

IV. Provider business mailing address

4295 GESNER ST STE 3A
SAN DIEGO CA
92117-6649
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CRAIG L DILLMAN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 619-275-0922