Healthcare Provider Details

I. General information

NPI: 1770732026
Provider Name (Legal Business Name): CRK CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51060 HAYES RD
MACOMB MI
48042-4057
US

IV. Provider business mailing address

14377 MORAVIAN MANOR CIR
STERLING HEIGHTS MI
48312-7101
US

V. Phone/Fax

Practice location:
  • Phone: 586-781-4314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301008834
License Number StateMI

VIII. Authorized Official

Name: DR. CHARLES R KRATZ
Title or Position: OWNER
Credential: D.C.
Phone: 586-781-4314