Provider Demographics
NPI:1275757668
Name:KRAUSE, GERALD (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:KRAUSE
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 1:730 S PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4205
Mailing Address - Country:US
Mailing Address - Phone:310-540-3355
Mailing Address - Fax:310-540-5226
Practice Address - Street 1:730 S PACIFIC COAST HWY
Practice Address - Street 2:SUITE #105
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4205
Practice Address - Country:US
Practice Address - Phone:310-540-3355
Practice Address - Fax:310-540-5226
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12452A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor