Healthcare Provider Details

I. General information

NPI: 1992883870
Provider Name (Legal Business Name): DAVID JAMES KREPS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 HIGHWAY 10 WEST SUITE B
DILWORTH MN
56529-1346
US

IV. Provider business mailing address

PO BOX 1275
MOORHEAD MN
56561-1275
US

V. Phone/Fax

Practice location:
  • Phone: 218-236-1187
  • Fax: 218-236-8514
Mailing address:
  • Phone: 218-236-1187
  • Fax: 218-236-8514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2116
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number346
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number488
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: