Provider Demographics
NPI:1891238374
Name:KRUEGER, KRISTEN C (DC)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:C
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:C
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1684 REUNION AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:801-562-0502
Mailing Address - Fax:801-254-6061
Practice Address - Street 1:1684 REUNION AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:801-562-0502
Practice Address - Fax:801-254-6061
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10935197-1202111N00000X
AL2518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor