Provider Demographics
NPI:1568503738
Name:ASHBY, CRAIG BENJAMIN (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:BENJAMIN
Last Name:ASHBY
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 1:16 S 1ST E
Mailing Address - Street 2:PO BOX 303
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1902
Mailing Address - Country:US
Mailing Address - Phone:208-359-6067
Mailing Address - Fax:208-359-6069
Practice Address - Street 1:16 S 1ST E
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1902
Practice Address - Country:US
Practice Address - Phone:208-359-6067
Practice Address - Fax:208-359-6069
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC8257OtherBLUE CROSS
IDC8240OtherBLUE CROSS
ID000010018730OtherBLUE SHIELD
ID000010018731OtherBLUE SHIELD
ID805045600Medicaid
ID805045600Medicaid
IDU67096Medicare UPIN