Provider Demographics
NPI:1053621474
Name:MACNEIL, CRAIG JUSTIN (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:JUSTIN
Last Name:MACNEIL
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 1:108 HURON BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1422
Mailing Address - Country:US
Mailing Address - Phone:770-639-7687
Mailing Address - Fax:
Practice Address - Street 1:108 HURON BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1422
Practice Address - Country:US
Practice Address - Phone:770-639-7687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor