MEDICARE: CRAFT CHIROPRACTIC CENTER PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0B31023	OTHER	MI	BCBS OF MICHIGAN

General Provider Information

NPI Number	:	1700849379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAFT CHIROPRACTIC CENTER PC

Provider Business Mailing Address
First Line	:	PO BOX 236
Second Line	:
City	:	CHARLOTTE
State	:	MI
Zip	:	48813-0236
Country	:	US
Telephone Number	:	517-543-1115
Fax Number	:	517-543-3290

Provider Business Practice Location Address
First Line	:	223 LANSING ST
Second Line	:
City	:	CHARLOTTE
State	:	MI
Zip	:	48813-1605
Country	:	US
Telephone Number	:	517-543-1115
Fax Number	:	517-543-3290

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DENNIS RAY CRAFT
Credential	:	DC
Telephone Number	:	517-543-1115

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	12/29/2016

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