MEDICARE: DR. CRAIG M. LEIS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1776	NC
2	111N00000X	Chiropractor	3436	SC

General Provider Information

NPI Number	:	1013903988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG M. LEIS D.C.

Provider Business Mailing Address
First Line	:	10384 TINTINHULL DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-1574
Country	:	US
Telephone Number	:	704-502-7897
Fax Number	:	704-327-0793

Provider Business Practice Location Address
First Line	:	10384 TINTINHULL DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-1574
Country	:	US
Telephone Number	:	704-502-7897
Fax Number	:	704-327-0793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	10/20/2021

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