Provider Demographics
NPI:1770635500
Name:KRASKOW, STEVEN P (DC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:KRASKOW
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 1:2 CORPORATE DR
Mailing Address - Street 2:STE 104
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917-4006
Mailing Address - Country:US
Mailing Address - Phone:845-928-7820
Mailing Address - Fax:845-928-7592
Practice Address - Street 1:2 CORPORATE DR
Practice Address - Street 2:STE 104
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-4006
Practice Address - Country:US
Practice Address - Phone:845-928-7820
Practice Address - Fax:845-928-7592
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-009929-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U68918Medicare UPIN
NYX4N241Medicare ID - Type Unspecified