Provider Demographics
NPI:1740650076
Name:PETERSON, CRAIG (ND LAC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:ND LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 PERRY AVE SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8098
Mailing Address - Country:US
Mailing Address - Phone:206-790-0584
Mailing Address - Fax:
Practice Address - Street 1:3700 PACIFIC HWY E
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-1148
Practice Address - Country:US
Practice Address - Phone:253-382-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60675686171100000X
WANT60255391175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist