Provider Demographics
NPI:1811042849
Name:KRUEGER, LYLE E (DC)
Entity Type:Individual
Prefix:DR
First Name:LYLE
Middle Name:E
Last Name:KRUEGER
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 1:1214 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3443
Mailing Address - Country:US
Mailing Address - Phone:563-264-8565
Mailing Address - Fax:
Practice Address - Street 1:1214 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3443
Practice Address - Country:US
Practice Address - Phone:563-264-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0157883Medicaid
IA0157883Medicaid
IA15788Medicare ID - Type Unspecified