Healthcare Provider Details

I. General information

NPI: 1982934907
Provider Name (Legal Business Name): CRAFT CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1586 44TH ST SW
WYOMING MI
49509-4314
US

IV. Provider business mailing address

1586 44TH ST SW
WYOMING MI
49509-4314
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-7040
  • Fax:
Mailing address:
  • Phone: 616-455-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301005297
License Number StateMI

VIII. Authorized Official

Name: DR. DENNIS CRAFT
Title or Position: MEMBER
Credential: D.C.
Phone: 517-543-1115