Provider Demographics
NPI:1447475371
Name:KIRSTEN KRAUSE CHIROPRACTIC INC
Entity type:Organization
Organization Name:KIRSTEN KRAUSE CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-364-6600
Mailing Address - Street 1:18805 COX AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6616
Mailing Address - Country:US
Mailing Address - Phone:408-364-6600
Mailing Address - Fax:408-364-2041
Practice Address - Street 1:18805 COX AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6616
Practice Address - Country:US
Practice Address - Phone:408-364-6600
Practice Address - Fax:408-364-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27313111N00000X
CA24456111N00000X
CADC24456111N00000X
CADC27313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ260812OtherMEDICARE PTAN
CAZZZ05176ZOtherBLUE SHIELD GROUP NUMBER
CAZZZ05176ZOtherBLUE SHIELD GROUP NUMBER
CADC0273130Medicare PIN