MEDICARE: DR. ALAN PAUL KRASNOFF D.C.

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	111NS0005X	Sports Physician Chiropractor	0104000242	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	460132	OTHER	VA	ASHN
2	075017	OTHER	VA	ANTHEM
3	460253	OTHER	VA	ACN

General Provider Information

NPI Number	:	1366544934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN PAUL KRASNOFF D.C.

Provider Business Mailing Address
First Line	:	1101 BATTLEFIELD BLVD N
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-4735
Country	:	US
Telephone Number	:	757-547-9266
Fax Number	:	757-547-9268

Provider Business Practice Location Address
First Line	:	1101 BATTLEFIELD BLVD N
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-4735
Country	:	US
Telephone Number	:	757-547-9266
Fax Number	:	757-547-9268

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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