Provider Demographics
NPI:1053319459
Name:KREUTZ, ROBERT STEVEN JR (BS, DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEVEN
Last Name:KREUTZ
Suffix:JR
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 79TH PL SW
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-6218
Mailing Address - Country:US
Mailing Address - Phone:425-387-2556
Mailing Address - Fax:425-353-1033
Practice Address - Street 1:13619 MUKILTEO SPEEDWAY STE B4
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-1671
Practice Address - Country:US
Practice Address - Phone:425-353-1011
Practice Address - Fax:425-353-1033
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB10963Medicare ID - Type Unspecified
U76529Medicare UPIN