Healthcare Provider Details

I. General information

NPI: 1609394667
Provider Name (Legal Business Name): CASEY KRAHN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 E COLLEGE AVE STE C
BLOOMINGTON IL
61704-2484
US

IV. Provider business mailing address

1004 BYPASS S UNIT 5
LAWRENCEBURG KY
40342-8047
US

V. Phone/Fax

Practice location:
  • Phone: 309-661-1155
  • Fax: 309-661-1155
Mailing address:
  • Phone: 502-839-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.13135
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: