Provider Demographics
NPI:1487855078
Name:KRUEGER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:KRUEGER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CARY
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-623-4687
Mailing Address - Street 1:436 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-1855
Mailing Address - Country:US
Mailing Address - Phone:715-623-4687
Mailing Address - Fax:715-623-0697
Practice Address - Street 1:436 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-1855
Practice Address - Country:US
Practice Address - Phone:715-623-4687
Practice Address - Fax:715-623-0697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3428012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035701Medicare PIN