Provider Demographics
NPI:1386795615
Name:SELZER, CRAIG (DC)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:
Last Name:SELZER
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 1:36 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-665-3714
Mailing Address - Fax:631-665-3749
Practice Address - Street 1:36 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-665-3714
Practice Address - Fax:631-665-3749
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX5B921Medicare UPIN
NYX5B921Medicare PIN
NYU56200Medicare UPIN