Provider Demographics
NPI:1134748817
Name:KROGUE, JONATHAN (DC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:KROGUE
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 1:1172 E 100 N STE 9
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1691
Mailing Address - Country:US
Mailing Address - Phone:801-691-1194
Mailing Address - Fax:
Practice Address - Street 1:1172 E 100 N STE 9
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1691
Practice Address - Country:US
Practice Address - Phone:801-691-1194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11544936-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor