Provider Demographics
NPI:1609904218
Name:KRUEGER, CHRIS TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:TODD
Last Name:KRUEGER
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:E9180 GOLF CLUB RD
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-9016
Mailing Address - Country:US
Mailing Address - Phone:715-823-2121
Mailing Address - Fax:715-823-5969
Practice Address - Street 1:E9180 GOLF CLUB RD
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-9016
Practice Address - Country:US
Practice Address - Phone:715-823-2121
Practice Address - Fax:715-823-5969
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3374-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38897300Medicaid
WI38897300Medicaid
WI70966Medicare ID - Type Unspecified