Provider Demographics
NPI:1245293521
Name:KRUSE, JOSHUA JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:JAMES
Last Name:KRUSE
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 1:330 DAKOTA DUNES BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5461
Mailing Address - Country:US
Mailing Address - Phone:605-217-2100
Mailing Address - Fax:605-217-2099
Practice Address - Street 1:330 DAKOTA DUNES BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5461
Practice Address - Country:US
Practice Address - Phone:605-217-2100
Practice Address - Fax:605-217-2099
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08655111N00000X
MN4953111N00000X
SD1240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA08390OtherBLUE CROSS OF IA
IA08390OtherBLUE SHIELD
SDS108002OtherPTAN
SD1245293521Medicare PIN