Provider Demographics
NPI:1942214853
Name:KRUEGER CHIROPRACTIC CLINIC INCORPORATED
Entity Type:Organization
Organization Name:KRUEGER CHIROPRACTIC CLINIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:KELSEY
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-393-9505
Mailing Address - Street 1:1653 LITITZ PIKE # 402
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6507
Mailing Address - Country:US
Mailing Address - Phone:717-393-9505
Mailing Address - Fax:717-393-9520
Practice Address - Street 1:1382 HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2613
Practice Address - Country:US
Practice Address - Phone:717-393-9505
Practice Address - Fax:717-393-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004774L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKR3561Medicare ID - Type Unspecified