MEDICARE: CRAIG A DITZLER DC

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	DC16342	CA

General Provider Information

NPI Number	:	1649261017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG A DITZLER DC

Provider Business Mailing Address
First Line	:	3202 GOVERNOR DR
Second Line	:	#200
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2938
Country	:	US
Telephone Number	:	858-452-2202
Fax Number	:	858-452-2379

Provider Business Practice Location Address
First Line	:	3202 GOVERNOR DR
Second Line	:	#200
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2938
Country	:	US
Telephone Number	:	858-452-2202
Fax Number	:	858-452-2379

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	07/08/2007

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Directions to “ CRAIG A DITZLER DC” Practice Location

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