Provider Demographics
NPI:1679680995
Name:KROES, KEVIN C (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
Last Name:KROES
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 1:18017 SKY PARK CIR STE F
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6579
Mailing Address - Country:US
Mailing Address - Phone:949-862-7499
Mailing Address - Fax:949-862-7496
Practice Address - Street 1:18017 SKY PARK CIR STE F
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6579
Practice Address - Country:US
Practice Address - Phone:949-862-7499
Practice Address - Fax:949-862-7496
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23037Medicare ID - Type Unspecified