Provider Demographics
NPI:1043641426
Name:KRAGT, JACOB DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:DANIEL
Last Name:KRAGT
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 1:1925 N WENATCHEE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-8332
Mailing Address - Country:US
Mailing Address - Phone:509-885-3999
Mailing Address - Fax:
Practice Address - Street 1:1925 N WENATCHEE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-8332
Practice Address - Country:US
Practice Address - Phone:509-885-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60429423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor