Provider Demographics
NPI:1962549386
Name:RUMMEL, CRAIG WILLARD (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WILLARD
Last Name:RUMMEL
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 158
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81626-0158
Mailing Address - Country:US
Mailing Address - Phone:970-824-7538
Mailing Address - Fax:970-824-2953
Practice Address - Street 1:333 E VICTORY WAY
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-1823
Practice Address - Country:US
Practice Address - Phone:970-824-7538
Practice Address - Fax:970-824-2953
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22853Medicare UPIN