Provider Demographics
NPI:1477252799
Name:KRUTSINGER, IAN (DC)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:KRUTSINGER
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 1:14456 W BOCA RATON RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5718
Mailing Address - Country:US
Mailing Address - Phone:319-430-1617
Mailing Address - Fax:
Practice Address - Street 1:7717 W DEER VALLEY RD STE 135
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2102
Practice Address - Country:US
Practice Address - Phone:623-512-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA119101111N00000X
AZ9366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor