MEDICARE: DR. RONALD KRAYNEK 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	2301002317	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH820012	OTHER	MI	M-CARE
2	95OH252520	OTHER	MI	PPO

General Provider Information

NPI Number	:	1649334020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD KRAYNEK DC

Provider Business Mailing Address
First Line	:	10350 JO ANN LN
Second Line	:
City	:	PLYMOUTH
State	:	MI
Zip	:	48170-3867
Country	:	US
Telephone Number	:	734-459-9280
Fax Number	:

Provider Business Practice Location Address
First Line	:	5816 N SHELDON RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-3153
Country	:	US
Telephone Number	:	734-451-1225
Fax Number	:	734-451-2813

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/09/2007

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