Provider Demographics
NPI:1992905038
Name:MARTIN, CRAIG JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:JOSEPH
Last Name:MARTIN
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 1:103 W COLLEGE AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5770
Mailing Address - Country:US
Mailing Address - Phone:920-830-4050
Mailing Address - Fax:920-734-4578
Practice Address - Street 1:103 W COLLEGE AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5770
Practice Address - Country:US
Practice Address - Phone:920-830-4050
Practice Address - Fax:920-734-4578
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38875600Medicare UPIN
WIU46592Medicare UPIN