Provider Demographics
NPI:1205910304
Name:LEAVITT, CRAIG MITCHELL (DC)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:MITCHELL
Last Name:LEAVITT
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 1:180 WHITE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1166
Mailing Address - Country:US
Mailing Address - Phone:732-530-1525
Mailing Address - Fax:732-530-1527
Practice Address - Street 1:180 WHITE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1166
Practice Address - Country:US
Practice Address - Phone:732-530-1525
Practice Address - Fax:732-530-1527
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04814111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2644883OtherAETNA HMO
5851224OtherAETNA TRADITIONAL
P1974471OtherOXFORD
2644883OtherAETNA HMO
5851224OtherAETNA TRADITIONAL