Provider Demographics
NPI:1629057195
Name:KROGH, KYLE DANA (DC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DANA
Last Name:KROGH
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 1:207 NE DELAWARE AVE
Mailing Address - Street 2:SUITE #22
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-6733
Mailing Address - Country:US
Mailing Address - Phone:515-963-3999
Mailing Address - Fax:515-963-9716
Practice Address - Street 1:207 NE DELAWARE AVE
Practice Address - Street 2:SUITE #22
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-6733
Practice Address - Country:US
Practice Address - Phone:515-963-3999
Practice Address - Fax:515-963-9716
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0437111Medicaid
IAI 13033Medicare ID - Type UnspecifiedGROUP MEMBER NUMBER
IA0437111Medicaid