Provider Demographics
NPI:1558343707
Name:KRAFT, BRADLEY D (DC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:D
Last Name:KRAFT
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 1:212 S BROADWAY
Mailing Address - Street 2:SUITE #4
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3867
Mailing Address - Country:US
Mailing Address - Phone:701-838-7676
Mailing Address - Fax:701-837-7962
Practice Address - Street 1:212 S BROADWAY
Practice Address - Street 2:SUITE #4
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3867
Practice Address - Country:US
Practice Address - Phone:701-838-7676
Practice Address - Fax:701-837-7962
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND704111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11762Medicaid
U88524Medicare UPIN
NDN21507Medicare PIN