Provider Demographics
NPI:1720348428
Name:ROBERT J. KRAUSE, D.C., P.C.
Entity Type:Organization
Organization Name:ROBERT J. KRAUSE, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES. OF CORP/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-839-2102
Mailing Address - Street 1:1729 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168
Mailing Address - Country:US
Mailing Address - Phone:317-839-2102
Mailing Address - Fax:317-838-9877
Practice Address - Street 1:1729 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168
Practice Address - Country:US
Practice Address - Phone:317-839-2102
Practice Address - Fax:317-838-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN51000089(CORP)111N00000X
IN08001009A(INDI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN342180Medicare UPIN