Provider Demographics
NPI:1215064738
Name:KRAGT, WARREN DEAN (DC)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:DEAN
Last Name:KRAGT
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 1:116 E. MAIN
Mailing Address - Street 2:
Mailing Address - City:RITZVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99169
Mailing Address - Country:US
Mailing Address - Phone:509-659-0703
Mailing Address - Fax:509-659-0701
Practice Address - Street 1:116 E. MAIN
Practice Address - Street 2:
Practice Address - City:RITZVILLE
Practice Address - State:WA
Practice Address - Zip Code:99169
Practice Address - Country:US
Practice Address - Phone:509-659-0703
Practice Address - Fax:509-659-0701
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2003333Medicaid
WA87182OtherDEPT. OF LABOR & INDUSTIE
WA2003333Medicaid