Provider Demographics
NPI:1306991112
Name:CRAIG, CALEB JEREMIAH (DC)
Entity type:Individual
Prefix:DR
First Name:CALEB
Middle Name:JEREMIAH
Last Name:CRAIG
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 1:500 E BENSON BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4148
Mailing Address - Country:US
Mailing Address - Phone:907-561-4474
Mailing Address - Fax:907-561-4191
Practice Address - Street 1:500 E BENSON BLVD
Practice Address - Street 2:STE 103
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4148
Practice Address - Country:US
Practice Address - Phone:907-561-4474
Practice Address - Fax:907-561-4191
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5888111NN1001X
AK535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1579313Medicaid
AKK165897Medicare PIN
AK1579313Medicaid