Provider Demographics
NPI:1962487660
Name:KRATZ CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:KRATZ CHIROPRACTIC PLLC
Other - Org Name:EXCEPTIONAL LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-703-0410
Mailing Address - Street 1:45637 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-6214
Mailing Address - Country:US
Mailing Address - Phone:568-566-0011
Mailing Address - Fax:
Practice Address - Street 1:45637 HAYES RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-6214
Practice Address - Country:US
Practice Address - Phone:568-566-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV02071OtherHAPPOM
MIV02071OtherHAPPOM
MI0P28010Medicare ID - Type UnspecifiedMEDICARE
MI=========OtherPPOM