Provider Demographics
NPI:1326015868
Name:KRUSE, RODNEY PAUL (DC)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:PAUL
Last Name:KRUSE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IL
Mailing Address - Zip Code:61856-1640
Mailing Address - Country:US
Mailing Address - Phone:217-962-9446
Mailing Address - Fax:217-762-9447
Practice Address - Street 1:113 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-1640
Practice Address - Country:US
Practice Address - Phone:217-962-9446
Practice Address - Fax:217-762-9447
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T38473Medicare UPIN
747980Medicare ID - Type Unspecified