Provider Demographics
NPI:1982817268
Name:KRUEGER FAMILY CHIROPRACTIC CLINIC P.C.
Entity Type:Organization
Organization Name:KRUEGER FAMILY CHIROPRACTIC CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-493-1441
Mailing Address - Street 1:7030-M SO. LEWIS
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136
Mailing Address - Country:US
Mailing Address - Phone:918-493-1441
Mailing Address - Fax:918-493-2879
Practice Address - Street 1:7030 S LEWIS AVE STE M
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3915
Practice Address - Country:US
Practice Address - Phone:918-493-1441
Practice Address - Fax:918-493-2879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2557111N00000X
OK#2557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK483860577Medicare ID - Type UnspecifiedPROVIDER NUMBER
OKU11956Medicare UPIN