Provider Demographics
NPI:1760611768
Name:KRAGE, JOHN SMITH (DC,QME, CCFC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SMITH
Last Name:KRAGE
Suffix:
Gender:M
Credentials:DC,QME, CCFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5333 MISSION CENTER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1302
Mailing Address - Country:US
Mailing Address - Phone:619-621-5520
Mailing Address - Fax:619-621-5521
Practice Address - Street 1:5333 MISSION CENTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1302
Practice Address - Country:US
Practice Address - Phone:619-621-5520
Practice Address - Fax:619-621-5521
Is Sole Proprietor?:No
Enumeration Date:2009-07-11
Last Update Date:2009-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14672111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic