Provider Demographics
NPI:1235460445
Name:KRUGMAN ENTERPRISES, INC.
Entity Type:Organization
Organization Name:KRUGMAN ENTERPRISES, INC.
Other - Org Name:ISLAND CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAXTON
Authorized Official - Middle Name:TATE
Authorized Official - Last Name:KRUGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:361-949-2199
Mailing Address - Street 1:14602 COMPASS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6207
Mailing Address - Country:US
Mailing Address - Phone:361-949-2199
Mailing Address - Fax:361-949-2847
Practice Address - Street 1:14602 COMPASS ST
Practice Address - Street 2:SUITE B
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6207
Practice Address - Country:US
Practice Address - Phone:361-949-2199
Practice Address - Fax:361-949-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186210Medicare UPIN