MEDICARE: TERRY MARTIN KRONLUND DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1616	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0007778	OTHER		DEPT OF LABOR & INDUSTRIE

General Provider Information

NPI Number	:	1376616078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY MARTIN KRONLUND DC

Provider Business Mailing Address
First Line	:	3820 SOUTH 320TH
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98001
Country	:	US
Telephone Number	:	253-839-2650
Fax Number	:	253-839-4528

Provider Business Practice Location Address
First Line	:	3820 SOUTH 320TH
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98001
Country	:	US
Telephone Number	:	253-839-2650
Fax Number	:	253-839-4528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	12/17/2007

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