Provider Demographics
NPI:1013032994
Name:KRATZ, DOUGLAS RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RICHARD
Last Name:KRATZ
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 1:2085 RIVER ESTATE LN
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-3331
Mailing Address - Country:US
Mailing Address - Phone:608-873-8876
Mailing Address - Fax:
Practice Address - Street 1:135 W MAIN ST
Practice Address - Street 2:STE. 200
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-2100
Practice Address - Country:US
Practice Address - Phone:608-873-3037
Practice Address - Fax:608-873-3053
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3653-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035312Medicare ID - Type UnspecifiedPROVIDER NUMBER