Provider Demographics
NPI:1619041639
Name:DAHL, CRAIG DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:DAVID
Last Name:DAHL
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 1:1101 SUPERMALL WAY STE 1269
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-6535
Mailing Address - Country:US
Mailing Address - Phone:253-269-0261
Mailing Address - Fax:253-269-0202
Practice Address - Street 1:1101 SUPERMALL WAY STE 1269
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-6535
Practice Address - Country:US
Practice Address - Phone:253-269-0261
Practice Address - Fax:253-269-0202
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8803100Medicare ID - Type UnspecifiedPERSONAL ID NUMBER
WA8803098Medicare ID - Type UnspecifiedGROUP ID NUMBER