Provider Demographics
NPI:1104084086
Name:WERNER, CRAIG ALLAN (DC)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALLAN
Last Name:WERNER
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 1:23008 NE SCHAUER DR
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-5171
Mailing Address - Country:US
Mailing Address - Phone:808-250-4042
Mailing Address - Fax:
Practice Address - Street 1:1312 VANDERCOOK WAY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3902
Practice Address - Country:US
Practice Address - Phone:360-266-8800
Practice Address - Fax:360-425-1277
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8900180OtherMEDICARE PTAN