Provider Demographics
NPI:1851353189
Name:KOEHLER, CRAIG CURTIS (DC)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:CURTIS
Last Name:KOEHLER
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 1:5891 WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4657
Mailing Address - Country:US
Mailing Address - Phone:714-846-3544
Mailing Address - Fax:714-840-0408
Practice Address - Street 1:5891 WARNER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-4657
Practice Address - Country:US
Practice Address - Phone:714-846-3544
Practice Address - Fax:714-840-0408
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA18483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18483Medicare PIN