Provider Demographics
NPI:1174586259
Name:CRAFT, DENNIS RAY (DC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:RAY
Last Name:CRAFT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 LANSING ST
Mailing Address - Street 2:PO BOX 236
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1605
Mailing Address - Country:US
Mailing Address - Phone:517-543-1115
Mailing Address - Fax:517-543-3290
Practice Address - Street 1:223 LANSING ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1605
Practice Address - Country:US
Practice Address - Phone:517-543-1115
Practice Address - Fax:517-543-3290
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2710757Medicaid
MI950B310230OtherBCBS OF MICHIGAN
MI2710757Medicaid
MI950B310230OtherBCBS OF MICHIGAN