Provider Demographics
NPI:1366523649
Name:KRAFT, GARRY G (DC)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:G
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 1:2045 SAVIERS RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3651
Mailing Address - Country:US
Mailing Address - Phone:805-483-2225
Mailing Address - Fax:805-486-4646
Practice Address - Street 1:2045 SAVIERS RD
Practice Address - Street 2:SUITE 6
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3651
Practice Address - Country:US
Practice Address - Phone:805-483-2225
Practice Address - Fax:805-486-4646
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 14671111N00000X
CO1896111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT17856Medicare ID - Type Unspecified