Provider Demographics
NPI:1821077694
Name:KRUSE, MARK A (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
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 1:4716 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-3020
Mailing Address - Country:US
Mailing Address - Phone:712-276-0712
Mailing Address - Fax:712-276-0718
Practice Address - Street 1:4716 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-3020
Practice Address - Country:US
Practice Address - Phone:712-276-0712
Practice Address - Fax:712-276-0718
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04452111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1070789OtherTITLE 19
IA6070OtherSIOUX VALLEY HEALTH
IA1070789Medicaid
IA49930OtherBLUE SHIELD
NENE26410OtherBLUE CROSS OF NE
IA49930OtherBLUE CROSS
IA1070789OtherTITLE 19
NENE26410OtherBLUE CROSS OF NE