Provider Demographics
NPI:1942393715
Name:BRUE, CRAIG W (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:W
Last Name:BRUE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:164 E RIDGE GLOW PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-7973
Mailing Address - Country:US
Mailing Address - Phone:520-531-1353
Mailing Address - Fax:520-575-7114
Practice Address - Street 1:63701 E SADDLEBROOKE BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-1273
Practice Address - Country:US
Practice Address - Phone:520-825-8182
Practice Address - Fax:520-825-8192
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ84718Medicare ID - Type Unspecified
AZT61590Medicare UPIN