Provider Demographics
NPI:1215588132
Name:KRUEGER, MICHAEL (DC, MS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 DEVLIN RD APT 104
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-3706
Mailing Address - Country:US
Mailing Address - Phone:608-434-2838
Mailing Address - Fax:
Practice Address - Street 1:5750 RIVERS AVE STE A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6029
Practice Address - Country:US
Practice Address - Phone:843-723-6475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor