Healthcare Provider Details

I. General information

NPI: 1003620907
Provider Name (Legal Business Name): AMBER KRUSNIAK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 NORTHLAND DR NE STE B
GRAND RAPIDS MI
49525-1081
US

IV. Provider business mailing address

9664 HAYDEN DR APT 5
MASCOUTAH IL
62258-5517
US

V. Phone/Fax

Practice location:
  • Phone: 616-314-7616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301401609
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: