Provider Demographics
NPI:1609938786
Name:KRAGEN, WILLIAM CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:KRAGEN
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 1:195 HANOVER ST
Mailing Address - Street 2:SUITE 42
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3749
Mailing Address - Country:US
Mailing Address - Phone:603-436-2115
Mailing Address - Fax:603-436-2115
Practice Address - Street 1:195 HANOVER ST
Practice Address - Street 2:SUITE 42
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3749
Practice Address - Country:US
Practice Address - Phone:603-436-2115
Practice Address - Fax:603-436-2115
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11009560183B111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0508465Y0NH01OtherBCBS
NH8465Medicare ID - Type Unspecified
T25762Medicare UPIN