Provider Demographics
NPI:1558487728
Name:KREBS, DOUGLAS RYAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RYAN
Last Name:KREBS
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 1:922 W DIVERSEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1416
Mailing Address - Country:US
Mailing Address - Phone:773-529-0057
Mailing Address - Fax:773-529-0231
Practice Address - Street 1:922 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1416
Practice Address - Country:US
Practice Address - Phone:773-529-0057
Practice Address - Fax:773-529-0231
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627810OtherBLUE CROSS BLUE SHIELD
IL7805296OtherAETNA
IL1627810OtherBLUE CROSS BLUE SHIELD
917920Medicare ID - Type Unspecified