Provider Demographics
NPI:1831315332
Name:KRONLUND CHIROPRACTIC CLINIC, INC., P.S.
Entity Type:Organization
Organization Name:KRONLUND CHIROPRACTIC CLINIC, INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRONLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-839-2650
Mailing Address - Street 1:3820 S 320TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-3115
Mailing Address - Country:US
Mailing Address - Phone:253-839-2650
Mailing Address - Fax:253-839-4528
Practice Address - Street 1:3820 S 320TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-3115
Practice Address - Country:US
Practice Address - Phone:253-839-2650
Practice Address - Fax:253-839-4528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0007778OtherDEPT. OF LABOR & INDUSTRI
WA2003176Medicaid