Provider Demographics
NPI:1578580106
Name:KRAFT, JAMES EDMUND (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDMUND
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 1:3330 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5426
Mailing Address - Country:US
Mailing Address - Phone:248-740-9100
Mailing Address - Fax:248-740-9131
Practice Address - Street 1:3330 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5426
Practice Address - Country:US
Practice Address - Phone:248-740-9100
Practice Address - Fax:248-740-9131
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006918111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
950F316710OtherBLUE CROSS
87958AOtherAHL
16163OtherMCARE
950F316710OtherBLUE CROSS
16163OtherMCARE