MEDICARE: DR. NICHOLAS J. KRYSL D.C.

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	1549	NE
2	111N00000X	Chiropractor	1164	SD

General Provider Information

NPI Number	:	1689811937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS J. KRYSL D.C.

Provider Business Mailing Address
First Line	:	2720 W MAIN ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8128
Country	:	US
Telephone Number	:	605-342-4333
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 W MAIN ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-8128
Country	:	US
Telephone Number	:	605-342-4333
Fax Number	:

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

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	06/04/2010

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