Provider Demographics
NPI:1396080404
Name:KRAFT PERFORMANCE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:KRAFT PERFORMANCE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-761-8115
Mailing Address - Street 1:7239 SAWMILL RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-5000
Mailing Address - Country:US
Mailing Address - Phone:614-761-8115
Mailing Address - Fax:614-761-9993
Practice Address - Street 1:7239 SAWMILL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-5000
Practice Address - Country:US
Practice Address - Phone:614-761-8115
Practice Address - Fax:614-761-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty