Provider Demographics
NPI:1992869671
Name:KRAVIS, JAMES BENNETT (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BENNETT
Last Name:KRAVIS
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 1:31395 W. 7 MILE RD.
Mailing Address - Street 2:SUITE G
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4334
Mailing Address - Country:US
Mailing Address - Phone:248-426-6600
Mailing Address - Fax:248-426-6603
Practice Address - Street 1:31395 W. 7 MILE RD.
Practice Address - Street 2:SUITE G
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4334
Practice Address - Country:US
Practice Address - Phone:248-426-6600
Practice Address - Fax:248-426-6603
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301300315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1467445775Medicaid
MI350031751OtherRAILROAD MEDICARE
MI4558432OtherAETNA
MI4558432OtherUS HEALTHCARE
MI676739OtherFOCUS ID#
MI950H252060OtherBCBS INDIVIDUAL
MI5219173OtherFIRST NETWORK CCN#
MI950H218980OtherBCBS GROUP #
MIP69203OtherBLUE CARE NETWORK
MI4558432OtherAETNA
MI0N45010Medicare ID - Type Unspecified