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NPI Code Detail

MEDICARE: DR. DOUGLAS RYAN KREBS DC

MEDICARE: DR. DOUGLAS RYAN KREBS 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
1111N00000XChiropractor038-009427IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11627810OTHERILBLUE CROSS BLUE SHIELD
27805296OTHERILAETNA

General Provider Information

NPI Number : 1558487728
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS RYAN KREBS DC
Provider Business Mailing Address
First Line : 922 W DIVERSEY PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1416
Country : US
Telephone Number : 773-529-0057
Fax Number : 773-529-0231
Provider Business Practice Location Address
First Line : 922 W DIVERSEY PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1416
Country : US
Telephone Number : 773-529-0057
Fax Number : 773-529-0231
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/14/2010

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