Provider Demographics
NPI:1336198944
Name:KRAFT CHIROPRACTIC - ROCHESTER INC.
Entity Type:Organization
Organization Name:KRAFT CHIROPRACTIC - ROCHESTER INC.
Other - Org Name:KRAFT CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:KRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-299-2620
Mailing Address - Street 1:165 W AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5002
Mailing Address - Country:US
Mailing Address - Phone:248-299-2620
Mailing Address - Fax:248-299-2627
Practice Address - Street 1:165 W AUBURN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5002
Practice Address - Country:US
Practice Address - Phone:248-299-2620
Practice Address - Fax:248-299-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI123532OtherPREFERRED CHOICES
MICH630035OtherM-CARE
MI5260086OtherAETNA
MIOP02950Medicare ID - Type Unspecified