Provider Demographics
NPI:1841595501
Name:EUBANK, CRAIG ALLEN (CRAIG EUBANK)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALLEN
Last Name:EUBANK
Suffix:
Gender:M
Credentials:CRAIG EUBANK
Other - Prefix:MR
Other - First Name:CRAIG
Other - Middle Name:
Other - Last Name:EUBANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRAIG EUBANK
Mailing Address - Street 1:2810 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2625
Mailing Address - Country:US
Mailing Address - Phone:360-296-8183
Mailing Address - Fax:
Practice Address - Street 1:1420 KING ST
Practice Address - Street 2:SUITE E
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6264
Practice Address - Country:US
Practice Address - Phone:360-650-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60088311225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist