Provider Demographics
NPI:1922017672
Name:KIRKDORFER, KRAIG ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KRAIG
Middle Name:ALAN
Last Name:KIRKDORFER
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 1:2560 S CLEVELAND AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2640
Mailing Address - Country:US
Mailing Address - Phone:269-982-1611
Mailing Address - Fax:269-982-1644
Practice Address - Street 1:2560 S CLEVELAND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2640
Practice Address - Country:US
Practice Address - Phone:269-982-1611
Practice Address - Fax:269-982-1644
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P29080Medicare ID - Type Unspecified