Provider Demographics
NPI:1104014000
Name:KRAFT, STEVEN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ROBERT
Last Name:KRAFT
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 1:300 N FERRY ST
Mailing Address - Street 2:STE D
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1166
Mailing Address - Country:US
Mailing Address - Phone:586-337-3178
Mailing Address - Fax:
Practice Address - Street 1:300 N FERRY ST
Practice Address - Street 2:STE D
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1166
Practice Address - Country:US
Practice Address - Phone:586-337-3178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950E053380OtherBCBS
MI480655Medicare UPIN
MI0N11670Medicare PIN