MEDICARE: NICHOLAS KRAETZER 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	111N00000X	Chiropractor	DC21027	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC0210270	OTHER	CA	BLUE SHIELD
2	DC21027	OTHER	CA	CHIROPRACTIC LICENSE

General Provider Information

NPI Number	:	1770664476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS KRAETZER D.C.

Provider Business Mailing Address
First Line	:	15550 ROCKFIELD BLVD
Second Line	:	B220
City	:	IRVINE
State	:	CA
Zip	:	92618-2720
Country	:	US
Telephone Number	:	949-598-9999
Fax Number	:	949-598-9990

Provider Business Practice Location Address
First Line	:	18837 BROOKHURST ST
Second Line	:	106
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-7301
Country	:	US
Telephone Number	:	714-964-5911
Fax Number	:	714-963-0673

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	10/06/2010

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