Healthcare Provider Details

I. General information

NPI: 1750389896
Provider Name (Legal Business Name): CRAIG BRUCE DENHOLM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6838 M 93 HWY S
GRAYLING MI
49738-7766
US

IV. Provider business mailing address

6838 M 93 HWY S
GRAYLING MI
49738-7766
US

V. Phone/Fax

Practice location:
  • Phone: 989-348-6600
  • Fax: 989-348-3537
Mailing address:
  • Phone: 989-348-6600
  • Fax: 989-348-3537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301005021
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: