Provider Demographics
NPI:1528126695
Name:CRAIG, SCOTT E (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:CRAIG
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 1:40 EAST CHERRY STREET
Mailing Address - Street 2:P O BOX 256
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170
Mailing Address - Country:US
Mailing Address - Phone:812-752-6202
Mailing Address - Fax:
Practice Address - Street 1:40 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-1814
Practice Address - Country:US
Practice Address - Phone:812-752-6202
Practice Address - Fax:812-752-9533
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001735A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000364837OtherBLUE CROSS PIN
INN292383OtherHARMONY HEALTH
IN200172470Medicaid
IN000000364837OtherBLUE CROSS PIN
IN176860IMedicare ID - Type Unspecified