Provider Demographics
NPI:1447357009
Name:KRAFT, GARY ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:KRAFT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 E AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3257
Mailing Address - Country:US
Mailing Address - Phone:701-222-4964
Mailing Address - Fax:701-222-4964
Practice Address - Street 1:3114 E AVENUE C
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3257
Practice Address - Country:US
Practice Address - Phone:701-222-4964
Practice Address - Fax:701-222-4964
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND4219OtherBLUE CROSS/BLUE SHIELD ND
ND4219OtherBLUE CROSS/BLUE SHIELD ND