Provider Demographics
NPI:1578762837
Name:KRUEGER FAMILY CHIROPRACTIC, S.C.
Entity Type:Organization
Organization Name:KRUEGER FAMILY CHIROPRACTIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DENMAN
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-236-6000
Mailing Address - Street 1:3180 OMRO RD
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-9311
Mailing Address - Country:US
Mailing Address - Phone:920-236-6000
Mailing Address - Fax:920-236-6006
Practice Address - Street 1:3180 OMRO RD
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-9311
Practice Address - Country:US
Practice Address - Phone:920-236-6000
Practice Address - Fax:920-236-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000035991OtherMEDICARE PTAN