Provider Demographics
NPI:1497802680
Name:DR CRAIG A. BENSON CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:DR CRAIG A. BENSON CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:AULD
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-779-9957
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 STE 214
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T02221Medicare UPIN