Provider Demographics
NPI:1639520570
Name:KOHOUT, CRAIG D (DC)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:D
Last Name:KOHOUT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7533 SUNWOOD DRIVE NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303
Mailing Address - Country:US
Mailing Address - Phone:763-712-5986
Mailing Address - Fax:763-712-3916
Practice Address - Street 1:7533 SUNWOOD DRIVE NW #212
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303
Practice Address - Country:US
Practice Address - Phone:763-712-5986
Practice Address - Fax:763-712-3916
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor