Provider Demographics
NPI:1639169642
Name:KRAUSE, KIRSTEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18805 COX AVENUE
Mailing Address - Street 2:SUITE #170
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4162
Mailing Address - Country:US
Mailing Address - Phone:408-364-6600
Mailing Address - Fax:408-364-2041
Practice Address - Street 1:18805 COX AVENUE
Practice Address - Street 2:SUITE #170
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4162
Practice Address - Country:US
Practice Address - Phone:408-364-6600
Practice Address - Fax:408-364-2041
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0244560Medicare ID - Type UnspecifiedMEDICARE