Provider Demographics
NPI:1679566871
Name:CRAFT, MARK R (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:CRAFT
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 1:38 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428-1017
Mailing Address - Country:US
Mailing Address - Phone:845-647-5430
Mailing Address - Fax:845-647-1195
Practice Address - Street 1:38 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-1017
Practice Address - Country:US
Practice Address - Phone:845-647-5430
Practice Address - Fax:845-647-1195
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXOO4213-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT52772Medicare UPIN
NYX23921Medicare ID - Type Unspecified