Provider Demographics
NPI:1457300410
Name:KRUEGER, KEITH KELSEY (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:KELSEY
Last Name:KRUEGER
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 1:1653 LITITZ PIKE
Mailing Address - Street 2:#402
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6507
Mailing Address - Country:US
Mailing Address - Phone:717-393-9505
Mailing Address - Fax:
Practice Address - Street 1:1382 HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2613
Practice Address - Country:US
Practice Address - Phone:717-393-9505
Practice Address - Fax:717-393-9520
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004774L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKR3561Medicare ID - Type Unspecified