Provider Demographics
NPI:1407961667
Name:KRUGMAN, TYSON JON (DC)
Entity Type:Individual
Prefix:DR
First Name:TYSON
Middle Name:JON
Last Name:KRUGMAN
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 1:2301 S LAKELINE BLVD
Mailing Address - Street 2:700
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4276
Mailing Address - Country:US
Mailing Address - Phone:512-401-2008
Mailing Address - Fax:512-401-2145
Practice Address - Street 1:2301 S LAKELINE BLVD
Practice Address - Street 2:700
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4276
Practice Address - Country:US
Practice Address - Phone:512-401-2008
Practice Address - Fax:512-401-2145
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2565OtherBCBS PROVIDER NUMBER
TX00177UMedicare ID - Type UnspecifiedMEDICARE ID #
TXU91894Medicare UPIN