Provider Demographics
NPI:1720747900
Name:KRUIS, SARAH JUNE LINDHOLM (DC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JUNE LINDHOLM
Last Name:KRUIS
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 1:625 E BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3476
Mailing Address - Country:US
Mailing Address - Phone:574-262-4402
Mailing Address - Fax:
Practice Address - Street 1:625 E BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3476
Practice Address - Country:US
Practice Address - Phone:574-262-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003273A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty