Provider Demographics
NPI:1336304815
Name:KRATZ FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:KRATZ FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:KRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-873-3037
Mailing Address - Street 1:1718 US HIGHWAY 51 AND 138
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-1908
Mailing Address - Country:US
Mailing Address - Phone:608-873-3037
Mailing Address - Fax:608-873-3053
Practice Address - Street 1:1718 US HIGHWAY 51 AND 138
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1908
Practice Address - Country:US
Practice Address - Phone:608-873-3037
Practice Address - Fax:608-873-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38977100Medicaid
WI000035312Medicare PIN