Provider Demographics
NPI:1518510536
Name:KRUSE CHIROPRACTIC CORP.
Entity Type:Organization
Organization Name:KRUSE CHIROPRACTIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:ANDERSEN
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:708-220-6809
Mailing Address - Street 1:3287 NE CATAMARAN TER
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4270
Mailing Address - Country:US
Mailing Address - Phone:708-220-6809
Mailing Address - Fax:
Practice Address - Street 1:3287 NE CATAMARAN TER
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4270
Practice Address - Country:US
Practice Address - Phone:708-220-6809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty