Provider Demographics
NPI:1902971534
Name:CRAFT CHIROPRACTIC ASSOCIATES
Entity Type:Organization
Organization Name:CRAFT CHIROPRACTIC ASSOCIATES
Other - Org Name:RAFT CHIROPRACTIC ASSOCIATES, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-647-5430
Mailing Address - Street 1:38 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428-1017
Mailing Address - Country:US
Mailing Address - Phone:845-647-5430
Mailing Address - Fax:845-647-1195
Practice Address - Street 1:38 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-1017
Practice Address - Country:US
Practice Address - Phone:845-647-5430
Practice Address - Fax:845-647-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCR0X4W0810Medicare ID - Type Unspecified