Healthcare Provider Details

I. General information

NPI: 1124210489
Provider Name (Legal Business Name): KENNETH KRUCHTEN, DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S 5TH ST
WATSEKA IL
60970-1659
US

IV. Provider business mailing address

209 S 5TH ST
WATSEKA IL
60970-1659
US

V. Phone/Fax

Practice location:
  • Phone: 815-432-6201
  • Fax: 815-432-5416
Mailing address:
  • Phone: 815-432-6201
  • Fax: 815-432-5416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number038005663
License Number StateIL

VIII. Authorized Official

Name: DR. KENNETH KRUCHTEN
Title or Position: OWNER
Credential: DC
Phone: 815-432-6201