Provider Demographics
NPI:1972530558
Name:KROUSE, MICHAEL B (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:KROUSE
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 1:95 MADISON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOORISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:973-267-1010
Mailing Address - Fax:973-267-5521
Practice Address - Street 1:95 MADISON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MOORISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-267-1010
Practice Address - Fax:973-267-5521
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00354400111N00000X
NJMC00354400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT92139Medicare UPIN
597-081Medicare PIN
NJ597081Medicare ID - Type Unspecified