Provider Demographics
NPI:1982820304
Name:RICHARD A.S. KRAGNESS LTD
Entity Type:Organization
Organization Name:RICHARD A.S. KRAGNESS LTD
Other - Org Name:SKYWAY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAGNESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-341-8017
Mailing Address - Street 1:825 NICOLLET MALL
Mailing Address - Street 2:SUITE 1548
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2606
Mailing Address - Country:US
Mailing Address - Phone:612-341-8017
Mailing Address - Fax:612-332-5972
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:SUITE 1548
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2606
Practice Address - Country:US
Practice Address - Phone:612-341-8017
Practice Address - Fax:612-332-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0H031KROtherBLUE CROSS, INDIVIDUAL PR
MN231280OtherACN PROVIDER NUMBER
MN0H030SKOtherBLUE CROSS, CLINIC