Provider Demographics
NPI:1881301505
Name:KRUIZE, TAYLOR ANN (DC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANN
Last Name:KRUIZE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ANN
Other - Last Name:THOOFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:104 W REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-1980
Mailing Address - Country:US
Mailing Address - Phone:507-532-2655
Mailing Address - Fax:507-532-2951
Practice Address - Street 1:104 W REDWOOD ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1980
Practice Address - Country:US
Practice Address - Phone:507-532-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor