Healthcare Provider Details

I. General information

NPI: 1568492296
Provider Name (Legal Business Name): EDWARD MICHAEL KRYS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date: 04/21/2022
Reactivation Date: 11/21/2022

III. Provider practice location address

477 S SPRING RD
ELMHURST IL
60126-3857
US

IV. Provider business mailing address

477 S SPRING RD
ELMHURST IL
60126-3857
US

V. Phone/Fax

Practice location:
  • Phone: 847-203-4534
  • Fax:
Mailing address:
  • Phone: 800-862-5914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number042621272
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038008124
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008124
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: