Provider Demographics
NPI:1609069434
Name:KRUGMAN FAMILY CHIROPRACTIC PA
Entity Type:Organization
Organization Name:KRUGMAN FAMILY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:JON
Authorized Official - Last Name:KRUGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-401-2008
Mailing Address - Street 1:909 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-5903
Mailing Address - Country:US
Mailing Address - Phone:512-633-5669
Mailing Address - Fax:512-401-2145
Practice Address - Street 1:2301 S LAKELINE BLVD
Practice Address - Street 2:STE:700
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3604
Practice Address - Country:US
Practice Address - Phone:512-401-2008
Practice Address - Fax:512-401-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9080305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU91894Medicare UPIN
TX00177UMedicare PIN