Provider Demographics
NPI:1225790959
Name:KRAUSE, CONNER JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:CONNER
Middle Name:JAMES
Last Name:KRAUSE
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 1:130 GEORGE ST APT 427
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-3180
Mailing Address - Country:US
Mailing Address - Phone:810-599-4848
Mailing Address - Fax:
Practice Address - Street 1:1750 E MAIN ST STE 140
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2363
Practice Address - Country:US
Practice Address - Phone:630-584-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038013725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor