Healthcare Provider Details

I. General information

NPI: 1467474890
Provider Name (Legal Business Name): CRAIG RONALD HIMMELSEHR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 FOREST LN S SUITE H
GARLAND TX
75042-7950
US

IV. Provider business mailing address

1530 FOREST LN S SUITE H
GARLAND TX
75042-7950
US

V. Phone/Fax

Practice location:
  • Phone: 972-272-8769
  • Fax: 972-272-8920
Mailing address:
  • Phone: 972-272-8769
  • Fax: 972-272-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8299
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4000
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: