MEDICARE: STEVEN R KRAFT DC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN1001X	Nutrition Chiropractor	2301007252	MI

General Provider Information

NPI Number	:	1205104916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN R KRAFT DC LLC

Provider Business Mailing Address
First Line	:	300 N FERRY ST
Second Line	:	STE D
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-1166
Country	:	US
Telephone Number	:	586-337-3178
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N FERRY ST
Second Line	:	STE D
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-1166
Country	:	US
Telephone Number	:	586-337-3178
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVEN ROBERT KRAFT
Credential	:	D.C.
Telephone Number	:	586-337-3178

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	02/03/2016

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