Provider Demographics
NPI:1396735072
Name:KRUSE, INGRID M (DC)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:M
Last Name:KRUSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 MARTIN ST S
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35128-2360
Mailing Address - Country:US
Mailing Address - Phone:205-405-6099
Mailing Address - Fax:205-338-4553
Practice Address - Street 1:1021 MARTIN ST S
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35128-2360
Practice Address - Country:US
Practice Address - Phone:205-338-4545
Practice Address - Fax:205-338-4553
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2037111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51534992OtherBCBS OF ALABAMA
AL331133195OtherAETNA
AL51534995OtherBCBS OF ALABAMA
AL51534995OtherBCBS OF ALABAMA
AL051534992Medicare ID - Type UnspecifiedMEDICARE