Provider Demographics
NPI:1780067256
Name:KRUSE, EMILY MICHELE (DC)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MICHELE
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 1:208 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1519
Mailing Address - Country:US
Mailing Address - Phone:618-939-3009
Mailing Address - Fax:
Practice Address - Street 1:208 E MILL ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1519
Practice Address - Country:US
Practice Address - Phone:618-939-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor