Provider Demographics
NPI:1194878363
Name:BARCOMB, CRAIG L (DC)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:L
Last Name:BARCOMB
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 1:1217 S EAST AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2344
Mailing Address - Country:US
Mailing Address - Phone:941-362-2000
Mailing Address - Fax:941-362-9114
Practice Address - Street 1:1217 S EAST AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2344
Practice Address - Country:US
Practice Address - Phone:941-362-2000
Practice Address - Fax:941-362-9114
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005461111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH0005461OtherWORKERS COMPENSATION
FL70963OtherBLUE CROSS BLUE SHIELD
FLCH0005461OtherWORKERS COMPENSATION
FL70963OtherBLUE CROSS BLUE SHIELD