Provider Demographics
NPI:1811011885
Name:KRAYNEK CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:KRAYNEK CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:KRAYNEK
Authorized Official - Suffix:
Authorized Official - Credentials:D,C,
Authorized Official - Phone:734-415-1225
Mailing Address - Street 1:5816 N SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3153
Mailing Address - Country:US
Mailing Address - Phone:734-451-1225
Mailing Address - Fax:734-451-2813
Practice Address - Street 1:5816 N SHELDON RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3153
Practice Address - Country:US
Practice Address - Phone:734-451-1225
Practice Address - Fax:734-451-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7269718Medicare UPIN
MI0H25252Medicare PIN