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NPI Code Detail

MEDICARE: CRAIG DEREK CUSHMAN D.C.

MEDICARE: CRAIG DEREK CUSHMAN 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
1111N00000XChiropractor2301009824MI

General Provider Information

NPI Number : 1174883748
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRAIG DEREK CUSHMAN D.C.
Provider Business Mailing Address
First Line : 710 E WASHINGTON ST
Second Line :
City : GREENVILLE
State : MI
Zip : 48838-2054
Country : US
Telephone Number : 616-754-9172
Fax Number : 616-754-1067
Provider Business Practice Location Address
First Line : 710 E WASHINGTON ST
Second Line :
City : GREENVILLE
State : MI
Zip : 48838-2054
Country : US
Telephone Number : 616-754-9172
Fax Number : 616-754-1067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2012
Last Update Date : 05/17/2012

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