Healthcare Provider Details

I. General information

NPI: 1700870359
Provider Name (Legal Business Name): CRAIG M BACHAR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 WEBB ST
OSPREY FL
34229-8952
US

IV. Provider business mailing address

23 WEBB ST
OSPREY FL
34229-8952
US

V. Phone/Fax

Practice location:
  • Phone: 941-966-5213
  • Fax: 941-966-5368
Mailing address:
  • Phone: 941-966-5213
  • Fax: 941-966-5368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0006714
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: