MEDICARE: KRUSE CHIROPRACTIC CORP.

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

General Provider Information

NPI Number	:	1518510536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRUSE CHIROPRACTIC CORP.

Provider Business Mailing Address
First Line	:	3287 NE CATAMARAN TER
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-4270
Country	:	US
Telephone Number	:	708-220-6809
Fax Number	:

Provider Business Practice Location Address
First Line	:	3287 NE CATAMARAN TER
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-4270
Country	:	US
Telephone Number	:	708-220-6809
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RALPH ANDERSEN KRUSE JR.
Credential	:	D.C.
Telephone Number	:	708-220-6809

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	07/18/2019

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