Provider Demographics
NPI:1699726117
Name:KRAUSE, ROBERT J (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
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 1:1729 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-1812
Mailing Address - Country:US
Mailing Address - Phone:317-839-2102
Mailing Address - Fax:317-838-9877
Practice Address - Street 1:1729 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-1812
Practice Address - Country:US
Practice Address - Phone:317-839-2102
Practice Address - Fax:317-838-9877
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN51000089A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000086249Medicare UPIN
IN342180Medicare ID - Type UnspecifiedMEDICARE PROVIDER #