Provider Demographics
NPI:1376616078
Name:KRONLUND, TERRY MARTIN (DC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:MARTIN
Last Name:KRONLUND
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 1:3820 SOUTH 320TH
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001
Mailing Address - Country:US
Mailing Address - Phone:253-839-2650
Mailing Address - Fax:253-839-4528
Practice Address - Street 1:3820 SOUTH 320TH
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001
Practice Address - Country:US
Practice Address - Phone:253-839-2650
Practice Address - Fax:253-839-4528
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2003176Medicaid
0007778OtherDEPT OF LABOR & INDUSTRIE
0007778OtherDEPT OF LABOR & INDUSTRIE