Provider Demographics
NPI:1790986016
Name:KRUSE, LUCAS WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:WAYNE
Last Name:KRUSE
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 1:6360 ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9371
Mailing Address - Country:US
Mailing Address - Phone:919-679-2850
Mailing Address - Fax:
Practice Address - Street 1:6360 ROGERS RD
Practice Address - Street 2:
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571-9371
Practice Address - Country:US
Practice Address - Phone:919-435-7020
Practice Address - Fax:919-435-7134
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910063Medicaid
NC5910063Medicaid