Provider Demographics
NPI:1700964632
Name:KRAGE, ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:KRAGE
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 1:10722 KATELLA AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-8104
Mailing Address - Country:US
Mailing Address - Phone:951-347-4043
Mailing Address - Fax:858-630-2538
Practice Address - Street 1:10722 KATELLA AVE STE 5
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-8104
Practice Address - Country:US
Practice Address - Phone:951-347-4043
Practice Address - Fax:858-630-2538
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24734111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330780915OtherPRACTICE TAX ID
CADC24734OtherBLUE CROSS OF CA
CADC0247340OtherBLUE SHIELD OF CA
CADC24734OtherBLUE CROSS OF CA
CADC24734Medicare PIN