Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 535 | AK |
Y | 111NN1001X | Nutrition | 5888 | CO |
NPI | 1306991112 |
---|---|
Provider Name | Dr. Caleb Jeremiah Craig |
First Address | Anchorage, AK 99503-4148 |
Second Address | Anchorage, AK 99503-4148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 04/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1579313 | (05) | AK |