Provider Demographics
NPI:1285684878
Name:KRAUSE, NICHOLAS ADAM (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ADAM
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 1:3257 19TH ST NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6796
Mailing Address - Country:US
Mailing Address - Phone:507-292-1800
Mailing Address - Fax:507-292-1804
Practice Address - Street 1:3257 19TH ST NW
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6796
Practice Address - Country:US
Practice Address - Phone:507-292-1800
Practice Address - Fax:507-292-1804
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN802079500Medicaid
MN350003196Medicare ID - Type Unspecified
MN802079500Medicaid