Provider Demographics
NPI:1649368507
Name:KRUSE, RALPH ANDERSEN JR (DC)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:ANDERSEN
Last Name:KRUSE
Suffix:JR
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 1:2417 W 183RD STREET
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430
Mailing Address - Country:US
Mailing Address - Phone:708-798-5556
Mailing Address - Fax:708-798-5550
Practice Address - Street 1:3287 NE CATAMARAN TER
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4270
Practice Address - Country:US
Practice Address - Phone:708-798-5556
Practice Address - Fax:708-798-5550
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
201582Medicare ID - Type Unspecified
U19761Medicare UPIN