Healthcare Provider Details

I. General information

NPI: 1306991112
Provider Name (Legal Business Name): CALEB JEREMIAH CRAIG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E BENSON BLVD STE 103
ANCHORAGE AK
99503-4148
US

IV. Provider business mailing address

500 E BENSON BLVD STE 103
ANCHORAGE AK
99503-4148
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-4474
  • Fax: 907-561-4191
Mailing address:
  • Phone: 907-561-4474
  • Fax: 907-561-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number535
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number5888
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: