Provider Demographics
NPI:1528593563
Name:KRAUTSACK LLC
Entity Type:Organization
Organization Name:KRAUTSACK LLC
Other - Org Name:EMERALD CITY FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUTSACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-226-3829
Mailing Address - Street 1:45 DIVISION AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2489
Mailing Address - Country:US
Mailing Address - Phone:541-226-3829
Mailing Address - Fax:541-320-9028
Practice Address - Street 1:45 DIVISION AVE
Practice Address - Street 2:SUITE H
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2489
Practice Address - Country:US
Practice Address - Phone:541-226-3829
Practice Address - Fax:541-320-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5780111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty