Provider Demographics
NPI:1780844415
Name:ELLEN KRUMME
Entity Type:Organization
Organization Name:ELLEN KRUMME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KRUMME
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-204-0050
Mailing Address - Street 1:5770 GATEWAY
Mailing Address - Street 2:SUITE103
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1897
Mailing Address - Country:US
Mailing Address - Phone:513-204-0050
Mailing Address - Fax:513-204-7960
Practice Address - Street 1:5770 GATEWAY
Practice Address - Street 2:SUITE103
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1897
Practice Address - Country:US
Practice Address - Phone:513-204-0050
Practice Address - Fax:513-204-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH28960944800OtherOHIO BWC
OH380597OtherANTHEM
OH380597OtherANTHEM