Provider Demographics
NPI:1528260502
Name:KRAKOW, ELLIOTT (DC)
Entity type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:
Last Name:KRAKOW
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 1:13366 KINGSBURY DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3920
Mailing Address - Country:US
Mailing Address - Phone:561-801-5301
Mailing Address - Fax:561-791-7727
Practice Address - Street 1:2529 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3005
Practice Address - Country:US
Practice Address - Phone:561-801-5301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22757Medicare ID - Type Unspecified
FLT29218Medicare UPIN