Provider Demographics
NPI:1902965916
Name:WEINER, CRAIG (DC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:WEINER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1258
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249
Mailing Address - Country:US
Mailing Address - Phone:360-331-5565
Mailing Address - Fax:360-331-7122
Practice Address - Street 1:2812 BAYVIEW RD
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260
Practice Address - Country:US
Practice Address - Phone:360-331-5565
Practice Address - Fax:360-331-7122
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU27780Medicare UPIN
WA8802378Medicare ID - Type Unspecified