Provider Demographics
NPI:1316967136
Name:MACKEY, CRAIG D (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:D
Last Name:MACKEY
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:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-0356
Mailing Address - Country:US
Mailing Address - Phone:859-238-9300
Mailing Address - Fax:859-238-9977
Practice Address - Street 1:100 BAUGHMAN AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-238-9300
Practice Address - Fax:859-238-9977
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4129111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000382972OtherANTHEM BC/BS
KY85000164Medicaid
KY0991801Medicare PIN
KYU48410Medicare UPIN
KY000000382972OtherANTHEM BC/BS