Provider Demographics
NPI:1467549303
Name:KRAUSS, JEDIDIAH F (DC)
Entity Type:Individual
Prefix:DR
First Name:JEDIDIAH
Middle Name:F
Last Name:KRAUSS
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 1:1001 TWELVE OAKS CENTER DRIVE
Mailing Address - Street 2:SUITE 1015
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391
Mailing Address - Country:US
Mailing Address - Phone:952-345-8244
Mailing Address - Fax:763-546-8793
Practice Address - Street 1:1001 TWELVE OAKS CENTER DRIVE
Practice Address - Street 2:SUITE 1015
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391
Practice Address - Country:US
Practice Address - Phone:952-345-8244
Practice Address - Fax:763-546-8793
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN001921111NI0900X
MN1921111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN554327400Medicaid
122231OtherHEALTH PARTNERS PROVIDER
MN230439OtherACN PROVIDER
979T9KROtherBCBS PROVIDER #
4402834OtherMEDICA PROVIDER
979T9KROtherBCBS PROVIDER #
MN554327400Medicaid