Provider Demographics
NPI:1619087236
Name:KREGE, ROB D (DC)
Entity Type:Individual
Prefix:DR
First Name:ROB
Middle Name:D
Last Name:KREGE
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 1:610 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57274
Mailing Address - Country:US
Mailing Address - Phone:605-345-4960
Mailing Address - Fax:605-345-4960
Practice Address - Street 1:610 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:SD
Practice Address - Zip Code:57274
Practice Address - Country:US
Practice Address - Phone:605-345-4960
Practice Address - Fax:605-345-4960
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD22167OtherSIOUX VALLEY
SD7600233Medicaid
SD4998661OtherWM BCBS
SD7600233Medicaid
U43597Medicare UPIN