Healthcare Provider Details

I. General information

NPI: 1700239001
Provider Name (Legal Business Name): KRUPKE CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17266 HIGHWAY 23 NE STE 101
NEW LONDON MN
56273-7816
US

IV. Provider business mailing address

PO BOX 99
NEW LONDON MN
56273-0099
US

V. Phone/Fax

Practice location:
  • Phone: 320-354-4793
  • Fax: 320-354-4585
Mailing address:
  • Phone: 320-354-4793
  • Fax: 320-354-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number111N00000X
License Number StateMN

VIII. Authorized Official

Name: DR. BRETT N KRUPKE
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 320-354-4793