MEDICARE: RALPH ANDERSEN KRUSE JR. 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	038006751	IL

General Provider Information

NPI Number	:	1649368507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH ANDERSEN KRUSE JR. DC

Provider Business Mailing Address
First Line	:	2417 W 183RD STREET
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430
Country	:	US
Telephone Number	:	708-798-5556
Fax Number	:	708-798-5550

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	:	708-798-5556
Fax Number	:	708-798-5550

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	06/06/2018

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