Healthcare Provider Details

I. General information

NPI: 1164577698
Provider Name (Legal Business Name): CRAFT CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9751 E GRAND RIVER AVE
PORTLAND MI
48875-9774
US

IV. Provider business mailing address

PO BOX 367
PORTLAND MI
48875-0367
US

V. Phone/Fax

Practice location:
  • Phone: 517-647-5770
  • Fax: 517-647-5773
Mailing address:
  • Phone: 517-647-5770
  • Fax: 517-647-5773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DENNIS R CRAFT
Title or Position: OWNER
Credential: DC
Phone: 517-647-5770