Provider Demographics
NPI:1457460636
Name:KRUGMAN, DAXTON TATE (DC)
Entity Type:Individual
Prefix:MR
First Name:DAXTON
Middle Name:TATE
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 1:14602 COMPASS ST
Mailing Address - Street 2:STE B
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6207
Mailing Address - Country:US
Mailing Address - Phone:361-949-2199
Mailing Address - Fax:361-949-2847
Practice Address - Street 1:14602 COMPASS ST
Practice Address - Street 2:STE B
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6207
Practice Address - Country:US
Practice Address - Phone:361-949-2199
Practice Address - Fax:361-949-2847
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606229OtherBLUE CROSS BLUE SHIELD
TX609591Medicare ID - Type Unspecified