Provider Demographics
NPI:1528042843
Name:KRIEG, KEVIN B (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:B
Last Name:KRIEG
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 1:1070 N RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-2004
Mailing Address - Country:US
Mailing Address - Phone:406-541-8888
Mailing Address - Fax:406-541-8891
Practice Address - Street 1:1070 N RUSSELL ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-2004
Practice Address - Country:US
Practice Address - Phone:406-541-8888
Practice Address - Fax:406-541-8891
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT950CHI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT40823OtherBLUE CROSS BLUE SHIELD
MTDA4988Medicare UPIN