Provider Demographics
NPI:1215909858
Name:KRAGT, STEVEN C
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:C
Last Name:KRAGT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-1230
Mailing Address - Country:US
Mailing Address - Phone:712-722-2965
Mailing Address - Fax:
Practice Address - Street 1:1236 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1230
Practice Address - Country:US
Practice Address - Phone:712-722-2965
Practice Address - Fax:712-722-2964
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
07427Medicare ID - Type Unspecified
IA4292150Medicare UPIN