Provider Demographics
NPI:1013133727
Name:KRACHT, SUSAN JOAN (DC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JOAN
Last Name:KRACHT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 OVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3591
Mailing Address - Country:US
Mailing Address - Phone:850-654-6912
Mailing Address - Fax:
Practice Address - Street 1:777 OVERBROOK DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-3591
Practice Address - Country:US
Practice Address - Phone:850-654-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582075035Medicare UPIN