MEDICARE: CRAFT CHIROPRACTIC ASSOCIATES

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

General Provider Information

NPI Number	:	1902971534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAFT CHIROPRACTIC ASSOCIATES

Provider Business Mailing Address
First Line	:	38 N MAIN ST
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-1017
Country	:	US
Telephone Number	:	845-647-5430
Fax Number	:	845-647-1195

Provider Business Practice Location Address
First Line	:	38 N MAIN ST
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-1017
Country	:	US
Telephone Number	:	845-647-5430
Fax Number	:	845-647-1195

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK R CRAFT
Credential	:	DC
Telephone Number	:	845-647-5430

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	06/09/2020

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