Provider Demographics
NPI:1700216421
Name:KRUSE CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:KRUSE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-750-0061
Mailing Address - Street 1:330 DAKOTA DUNES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5462
Mailing Address - Country:US
Mailing Address - Phone:605-217-2100
Mailing Address - Fax:605-217-2099
Practice Address - Street 1:330 DAKOTA DUNES BLVD STE 300
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5462
Practice Address - Country:US
Practice Address - Phone:605-217-2100
Practice Address - Fax:605-217-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty