Provider Demographics
NPI:1871662874
Name:KRUMRAI, DALE JOHN (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:JOHN
Last Name:KRUMRAI
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S WISCONSIN AVE
Mailing Address - Street 2:P.O. BOX 143
Mailing Address - City:PULASKI
Mailing Address - State:WI
Mailing Address - Zip Code:54162-0143
Mailing Address - Country:US
Mailing Address - Phone:920-822-5441
Mailing Address - Fax:920-822-1635
Practice Address - Street 1:415 S WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:WI
Practice Address - Zip Code:54162-0143
Practice Address - Country:US
Practice Address - Phone:920-822-5441
Practice Address - Fax:920-822-1635
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2449012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38841700Medicaid
T83405Medicare UPIN
WI70550Medicare ID - Type Unspecified