Provider Demographics
NPI:1093591919
Name:KRUMMICK, SHANE MASON (ATS)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:MASON
Last Name:KRUMMICK
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 JESSICA DR
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-1486
Mailing Address - Country:US
Mailing Address - Phone:847-650-5400
Mailing Address - Fax:
Practice Address - Street 1:990 JESSICA DR
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-1486
Practice Address - Country:US
Practice Address - Phone:847-650-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer