Provider Demographics
NPI:1215984463
Name:BROMLEY, CRAIG C (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:C
Last Name:BROMLEY
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 1:112 J D PARK RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 J D PARK RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9034
Practice Address - Country:US
Practice Address - Phone:304-520-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00519900111N00000X
PADC007362L111N00000X
WV834111N00000X
DEF1-0000469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2007144000OtherAMERIHEALTH INDIVIDUAL
NJ3097723OtherAETNA
NJ0037593OtherCIGNA PPO
NJ2153085000OtherAMERIHEALTH GROUP
NJ2007144000OtherAMERIHEALTH INDIVIDUAL
NJ3097723OtherAETNA