MEDICARE: RICHARD A.S. KRAGNESS LTD

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	2539	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0H031KR	OTHER	MN	BLUE CROSS, INDIVIDUAL PR
2	231280	OTHER	MN	ACN PROVIDER NUMBER
3	0H030SK	OTHER	MN	BLUE CROSS, CLINIC

General Provider Information

NPI Number	:	1982820304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD A.S. KRAGNESS LTD

Provider Business Mailing Address
First Line	:	825 NICOLLET MALL
Second Line	:	SUITE 1548
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2606
Country	:	US
Telephone Number	:	612-341-8017
Fax Number	:	612-332-5972

Provider Business Practice Location Address
First Line	:	825 NICOLLET MALL
Second Line	:	SUITE 1548
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2606
Country	:	US
Telephone Number	:	612-341-8017
Fax Number	:	612-332-5972

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD KRAGNESS
Credential	:	D.C.
Telephone Number	:	612-341-8017

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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