Provider Demographics
NPI:1184603078
Name:KRUEGER, WILLIAM BRADLEY (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRADLEY
Last Name:KRUEGER
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 1:5270 N PARK PL NE
Mailing Address - Street 2:STE. 120
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6222
Mailing Address - Country:US
Mailing Address - Phone:319-826-2924
Mailing Address - Fax:319-826-2641
Practice Address - Street 1:5270 N PARK PL NE
Practice Address - Street 2:STE. 120
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6222
Practice Address - Country:US
Practice Address - Phone:319-826-2924
Practice Address - Fax:319-826-2641
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0106229Medicaid
IA0106229Medicaid
IAU46552Medicare UPIN
IA0106229Medicaid