Provider Demographics
NPI:1801210224
Name:KRUG, LUCAS DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:DEAN
Last Name:KRUG
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:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:MN
Mailing Address - Zip Code:56209-0255
Mailing Address - Country:US
Mailing Address - Phone:952-923-4868
Mailing Address - Fax:
Practice Address - Street 1:112 S 4TH ST
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:MN
Practice Address - Zip Code:56209-0083
Practice Address - Country:US
Practice Address - Phone:952-923-4868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor