Provider Demographics
NPI:1912440025
Name:KROLL, BRENT
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:KROLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 GRAND AVE
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4275
Mailing Address - Country:US
Mailing Address - Phone:515-225-9200
Mailing Address - Fax:515-225-0123
Practice Address - Street 1:7205 VISTA DR
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-9360
Practice Address - Country:US
Practice Address - Phone:515-225-9200
Practice Address - Fax:515-225-0123
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA084964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor