Provider Demographics
NPI:1164629036
Name:KRUKOWSKI, JODY (NMD)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:
Last Name:KRUKOWSKI
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10416 CONSER ST APT 1D1
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-2632
Mailing Address - Country:US
Mailing Address - Phone:602-320-2990
Mailing Address - Fax:816-471-7225
Practice Address - Street 1:1810 SUMMIT ST # 101
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2109
Practice Address - Country:US
Practice Address - Phone:816-471-7227
Practice Address - Fax:816-471-7225
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-994175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath