MEDICARE: DR. CRAIG A BENSON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2079	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06307	OTHER	WA	DEPARTMENT OF LABOR & IND
2	005969001	OTHER	WA	GROUP HEALTH COOPERATIVE
3	BE6144	OTHER	WA	REGENCE BLUE SHIELD

General Provider Information

NPI Number	:	1033114236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG A BENSON DC

Provider Business Mailing Address
First Line	:	PO BOX 1893
Second Line	:
City	:	POULSBO
State	:	WA
Zip	:	98370-0270
Country	:	US
Telephone Number	:	360-779-9957
Fax Number	:	360-779-5848

Provider Business Practice Location Address
First Line	:	17791 FJORD DR NE
Second Line	:	STE 214
City	:	POULSBO
State	:	WA
Zip	:	98370-8481
Country	:	US
Telephone Number	:	360-779-9957
Fax Number	:	360-779-5848

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. CRAIG A BENSON DC” Practice Location

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