Provider Demographics
NPI:1184059222
Name:WARREN D KRAGT DC
Entity type:Organization
Organization Name:WARREN D KRAGT DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KRAGT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-659-0703
Mailing Address - Street 1:116 E MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:RITZVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99169-1406
Mailing Address - Country:US
Mailing Address - Phone:509-659-0703
Mailing Address - Fax:509-659-0701
Practice Address - Street 1:116 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:RITZVILLE
Practice Address - State:WA
Practice Address - Zip Code:99169-1406
Practice Address - Country:US
Practice Address - Phone:509-659-0703
Practice Address - Fax:509-659-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011859225700000X
WACH0001974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty