Provider Demographics
NPI:1033114236
Name:BENSON, CRAIG A (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:BENSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1893
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0270
Mailing Address - Country:US
Mailing Address - Phone:360-779-9957
Mailing Address - Fax:360-779-5848
Practice Address - Street 1:17791 FJORD DR NE
Practice Address - Street 2:STE 214
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8481
Practice Address - Country:US
Practice Address - Phone:360-779-9957
Practice Address - Fax:360-779-5848
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA06307OtherDEPARTMENT OF LABOR & IND
WA005969001OtherGROUP HEALTH COOPERATIVE
WABE6144OtherREGENCE BLUE SHIELD
WA000200472Medicare UPIN