Provider Demographics
NPI:1376776773
Name:KREUSEL, KORY LANDON (DC)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:LANDON
Last Name:KREUSEL
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 1:376 S LATAH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1539
Mailing Address - Country:US
Mailing Address - Phone:208-338-9111
Mailing Address - Fax:208-331-2347
Practice Address - Street 1:376 S LATAH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1539
Practice Address - Country:US
Practice Address - Phone:208-338-9111
Practice Address - Fax:208-331-2347
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor