Provider Demographics
NPI:1508870619
Name:KROUSE, CHRIS C (DO)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:C
Last Name:KROUSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 N FOSTER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2969
Mailing Address - Country:US
Mailing Address - Phone:605-996-3963
Mailing Address - Fax:
Practice Address - Street 1:625 N FOSTER ST
Practice Address - Street 2:SUITE 107
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2969
Practice Address - Country:US
Practice Address - Phone:605-996-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5883204C00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI25487Medicare UPIN