MEDICARE: MARK GRADWELL KRAUSE DC

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	111N00000X	Chiropractor	14116	CA

General Provider Information

NPI Number	:	1386695609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK GRADWELL KRAUSE DC

Provider Business Mailing Address
First Line	:	2345 FLETCHER PKWY
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-2134
Country	:	US
Telephone Number	:	619-460-4465
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 FLETCHER PKWY
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-2134
Country	:	US
Telephone Number	:	619-460-4465
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	01/22/2019

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