Provider Demographics
NPI:1386788545
Name:PAULS, CRAIG R (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:R
Last Name:PAULS
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 1:640 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-6838
Mailing Address - Country:US
Mailing Address - Phone:815-235-2301
Mailing Address - Fax:
Practice Address - Street 1:640 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-6838
Practice Address - Country:US
Practice Address - Phone:815-235-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38972400Medicaid
WI38972400Medicaid
WI38972400Medicaid