Provider Demographics
NPI:1063518298
Name:LONGWORTH, CRAIG WILLIAM (DC)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:WILLIAM
Last Name:LONGWORTH
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 1:8070 LAURA ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9305
Mailing Address - Country:US
Mailing Address - Phone:330-854-2229
Mailing Address - Fax:
Practice Address - Street 1:7023 MEARS GATE DR NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8849
Practice Address - Country:US
Practice Address - Phone:330-494-5554
Practice Address - Fax:330-494-2792
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000134672OtherANTHEM BCBS
OH0698384Medicaid
OHLO0612981Medicare ID - Type Unspecified