Provider Demographics
NPI:1679661698
Name:KRUSE-MANLEY CLINIC OF CHIROPRACTIC
Entity Type:Organization
Organization Name:KRUSE-MANLEY CLINIC OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-276-0712
Mailing Address - Street 1:4716 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-3020
Mailing Address - Country:US
Mailing Address - Phone:712-276-0712
Mailing Address - Fax:712-276-0718
Practice Address - Street 1:4716 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-3020
Practice Address - Country:US
Practice Address - Phone:712-276-0712
Practice Address - Fax:712-276-0718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0201244Medicaid
IA49928OtherBLUE CROSS OF IA
IA49928OtherBLUE SHIELD
IA49928OtherBLUE SHIELD
IA49928Medicare ID - Type Unspecified